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Independents' Day

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)

  • 1.We have to do something to improve our working conditions. This would immediately free up 1-2 hours per day, and urgent visits would stop the chaos of duty surgeries.
    2.Similar to OOH, visits are undervalued in the contract : it will cost DoH much more to commission a separate service.
    3.Also similar to the loss of OOH in 2004, something needs to happen to improve the morale of GPs, otherwise we will not be able to attract new GPs into the profession.
    4. But watch out : loss of visits could end practice boundaries...leading to destabilisation of list sizes.

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  • The system becomes unmanageable when abused. Home visits used to be requested for genuine clinical reasons only on the whole and with consideration for the doctor (so not the late Friday afternoon “like this all week” demand). Once you add in the requests on the grounds of no car/relatives too busy/don’t like to trouble them/it’s my right/it’s your job/it’s snowing etc. the stress about the wasted time mounts, I find. Perhaps an NHS taxi service would help (at a cost to patients).

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  • Vinci Ho

    Again I deliberately waited until you guys had expressed your well respected opinions and they indeed constitute mixed reactions :
    (1) Undoubtedly, the time spent on visiting one patient can always be used to see at least , several patients in surgery , fact and common sense .
    (2) Then it is the ‘type’ of patient who can genuinely ‘qualify’ for a home visit . Deep down, we all know who they are . But the question is who and how to justify the qualification of the home visit ? Arguably , this can be something potentially ‘abusable’ . I suppose every single case can be debated whether the patient really could have come to our surgeries to see us or not . Means of transport is one major factor , I suppose .
    (3) History does not help because it has created expectations . In the ‘old , good’ days , one can say we have enough resources ( time and manpower ) to satisfy these expectations. Yes , continuity of care(COC) is important. But it was then , this is now . General practice can barely survive under this current retention and recruitment crisis . The ‘right’ thing to do could have become the ‘wrong’ thing to do at the wrong place at the wrong time . Morale amongst our colleagues is so low that we must save ourselves before saving others . The fact we are moving towards working by scale sacrificing COC ( something I always fight for ) is arguably and already a form of capitulation. Let’s be honest to ourselves . Perhaps , home visit is just another ‘virtue’ we have to give up to endure our survival. Of course , politicians would not let this happen easily for their own sake ( Since when would they really want to care about ‘overpaid’ NHS GP?).

    I would be more than interested in the outcome of this ballot on 22/11( as well as the one about rejection of PCN) .
    The irony is PCN DES has included paramedics in the extended workforce deal , who can potentially do home visits for us. But we have to foot 30% of the cost at PCN . And we all wonder where the hell can they recruit these paramedics without destabilising the already precarious ambulance services ?😈👿

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  • This is a great idea.

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  • I actually think this would entice me back to General practice. I absolutely hate home visits and the amount of time they take. Also the number of arguments they cause.

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  • The danger in not having home visits coupled to the loss of practice boundaries propels us towards a cost saving model of centralised GP sheds. This would save NHSE a fortune in rent alone and would seemingly facilitate a corporate structure of provision. There are pro's and con's to this, but I can't see it leading to greater influence and improved terms for gp's.

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  • As a profession I think, and said at the time, that it was a big mistake allowing Out of Hours to no longer be part of the contract. It was the beginning of the perception that GPs were overpaid and only interested in money. We have been the target of the media ever since. This may well just add to perception that we don’t want to leave our surgeries and only want to work Monday to Friday during working hours. We are playing into the hands of government (of either party) if this goes through. Better to retain control and argue that this should be adequately funded. I admit that I never liked visiting, but the contract says a visit is only required if you and the patient agree that a visit is clinically necessary. There is no reason why PCNs could not set up a local visiting system. The perception of General Practice will suffer yet another nail in the coffin. Be careful what you wish for

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  • Some ccgs have started pilot where all oph and nursing home visits are done by a gp who works full time for them.and is employed by CCG

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  • I worked in Canada for years no one expected or did home visits
    GP's were well respected and liked , far more than in UK with our servile approach to patients lest we upset them and they complain I Have paid my taxes mentality
    Perhaps that is why I met so many GP from UK in Canada and hardly ever(actualy never) meet a canadian GP in UK

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  • Just Your Average Joe

    Home visits are only appropriate when clinically required - judgement call of GP.

    Not a good use of time - and need to be removed from day to day workload to improve morale.

    Time not to cause a political own goal to remove from core contract with all media negativity attached, but to use the lemons the DOH has thrown at us and make lemonade.

    The PCN/federations where formed are political vehicles which could be devolved the role locally and take this workload off with visiting services set up, outside the practice workload.

    With shared records a level of continuity of care can be maintained and no need to isolate those patients from the other benefits of GP care and the practice team.

    Win/win for all involved.

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