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GP leaders to call for removal of home visits from contract

English GP leaders are calling for a removal of home visits from the core contract work because GPs no longer have the capacity to carry them out.

LMC leaders will vote on a motion at the England LMCs conference on 22 November, calling for the GP Committee England to negotiate a change.

Kent LMC, which has proposed the motion, will debate on whether to instruct the GPC to negotiate a separate acute service for urgent home visits.

The LMC says that GPs can no longer carry out home visits as part of their current core work.

The current GP contract outlines other healthcare professionals such as physician associates and advanced paramedic practitioners to undertake home visits once they are recruited.

GPs in the area have sympathised with the motion, including Kent dispensing GP Dr Mark Ironmonger.

Kent locum GP Dr Andy Parkin, who put forward the motion said the reason was to 'remove the expectation' that home visits are part of general practice.

He said: ‘Even though I don’t tend to do home visits as they’re not part of my terms and conditions, I will do them if needed and they’re paid for.

‘The main thing is the workload and demand on time in general practice. It’s not to remove the ability to do home visits if GPs want to. If there are truly house-bound patients or palliative care patients, I think GPs should still be able to do that.

‘The key thing is to remove the expectation that home visits are a part of general practice. They are the most time-consuming part of the job; they are one of the most litigious parts of the job. Even trying to triage visits causes a lot of aggravation from patients who ring up and want a visit and don’t need a home visit.’

He added that not only is the difficulty from rising GP workload but also from widening GP footprint.

He said: 'With the GP footprint getting wider from PCNs and mergers, visits can be a long way away. They can take an hour to go and get back. There isn’t that free time in general practice anymore.’

He continued: ‘In Kent, there is a home visiting service run by paramedics and nurses. Urgent visits requests are passed over to them but they have a limited capacity. Where there are seven visit requests, only two are passed over which still leaves five for us.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: 'Home visits can be very time consuming and take the GP away from the surgery when they could be seeing other patients, and where there are far better facilities to properly assess patients.

'But for some of our more complex and vulnerable patients, home visits are an invaluable, and often the only, means of seeing their GP.

'We are very supportive of proposals to train other members of the GP team such as physician associates and advanced paramedics to carry out home visits as appropriate, but they are not a substitute for GPs and it is vital that patients who need the skills of a GP are able to access them.'

Welsh GPs recently called for afternoon home visits to be passed onto ambulance services at the Wales LMCs conference over the weekend.

But delegates at the conference voted against motion, which argued that the Welsh GPC should negotiate an amendment to the GP contract so that urgent home visits after 2pm would be passed on the urgent care services.

Motion in full:

KENT: That conference believes that GPs no longer have the capacity to offer home visits and instructs the GPC England to:

i. remove the anachronism of home visits from core contract work

ii. negotiate a separate acute service for urgent visits

iii. demand any change in service is widely advertised to patients.

Readers' comments (50)

  • If home visits are to continue they must be properly resourced - both in time and remuneration. I would happily do appropriate home visits if I had a dedicated hour (per visit) in which to do so, but cramming them into an already overstretched working day is not sustainable.

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  • we are not doing our patients a service by continuing to provide an ad hoc service with little or no continuity of care, especially if provided by locums - other countries have dedicated hospice services for end of life care at home and nursing homes pay for an allocated GP to manage their patients, this leads to better management of patients and are more likely to die in their place of preference rather than an acute hospital ward. most people get to surgery to avoid paying for a home visit - as in other countries - the permanently housebound could have a dedicated home visiting service provided by interested doctors and staff. each home visit can take over an hour in travel, visit time then the writing up and sorting out extra care or phone calls, they are often complex with extensive social issues. it really is an expensive use of my lunch time having to sort out extra social care for a patient in need. resources could be better used to run such a service by a dedicated team. it was ok when it was just one or two visits but now it can be 10 or 12. trying to drive in lunch hour rush hour traffic can make a home visit over 2 hours in time. It really is not a good use of GP time to be sat in a car stuck in traffic when we could be seeing patients in surgery or on line. the world has changed. so should we.

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  • Never did one home visit in a year working as a GP in Canada. So why is it just the UK where GPs carry out HVs

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  • I may have continued to work full time if it was not home visits. Now I do surgery only and no visits

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  • If we stopped home visits, we would lose something. But the gain in morale and retention would massively exceed it.

    We need to have a maximum workload defined. In today's world, 12 x 15 min consults per session. Of course this could lead to gaming, filling your clinics with your favorite easy patients, but the alternative of all you can eat care is the real cause of the hemorrhage of GP's

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  • Most visits are not necessary, most are for reassurance, rarely a diagnosis is made that warrants an urgent A and E attendance,
    patients demand them because they know they can get it, carers also request them for trivial issues which are blown out of proportion, some threaten if the GP dithers,
    i do most to avoid a complaint and for my peace of mind

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  • DrRubbishBin

    great idea but no chance

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  • Hi Tony, are Canadians suffering poorer health or dying because there are no home visits? I guess not.

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  • Home visits are unheard of in Australian practice - probably before patients have to contribute towards the cost.
    Patients make it in to the surgery..
    I think nhs free at the point of delivery to me means the practice not your home. Let's be really honest if the patient that sick or frail they should be in hospital, in a nursing home or under a visiting palliative care service.
    I particularly like comments "not for a visit today as I am out at my hairdresser..."
    It is only going to get worse with the entitled baby boomers hitting old age!

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  • P.S We had a community geriatrics who did a whole 2 visits for her entire afternoon work. Needless to say she has stopped doing them down to the pressure

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