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GP leaders call for afternoon home visits to be passed onto ambulance services

Welsh GP leaders are calling for a change in their contract so that urgent afternoon home visits are handled by emergency healthcare services

GP leaders will vote on a motion calling for the change at the Welsh LMCs conference in Llandudno on 9 November.

Dyfed Powis LMC, which has proposed the motion, will argue that the BMA's Welsh GP Committee should negotiate an amendment to the GP contract so that urgent home visits after 2pm are passed onto urgent care or ambulance services for review.

The Welsh Ambulance Service NHS Trust and NHS 111, alongside care homes, carers and other health professionals, are increasingly asking GPs to conduct home visits, which take on average two to three hours, according to the BMA.

GPs told the BMA that home visits can be 'very disruptive' to practices, especially those managed single-handedly, given the ongoing workforce shortage in primary care and difficulties to cope with rising workloads.

GPs said the change would help address workload issues and mitigate the 'ever-growing demand' for GP services in light of a shrinking number of GPs.

Dr Eamonn Jessup, a GP in Prestatyn, North Wales said: 'This is a very interesting motion. It gives a possible partial solution to the issue of how to control an ever-growing demand for GP services from a population being served by a shrinking number of GPs.

'The majority of GPs feel there has to be a limit on the workload expected of GPs and this is a potential solution clearly worthy of debate. This is however fraught with difficulty. Would it be for all patients, how about the terminally ill patient? Will it lead to a further fragmenting of care?'

He added: 'This is, without doubt, a motion borne from the frustration of ever-increasing workload seeming to be unstoppable with an ever diminishing workforce. Somehow something has to change.'

Other motions that will be debated include:

  • A push for GPC Wales to remind service providers, in particular Welsh Ambulance Service Trust (WAST) and NHS 111, that GPs are not an emergency response provider; as the conference believes that the Welsh Government and health boards must stop the practice of GPs being expected to attend emergencies outside of practices as a replacement for a faltering ambulance service and hospital overcrowding; 
  • Assurance from the Wales general medical practice indemnity scheme that GPs will be supported when standards are breached and work dumped on GPs is handed back to secondary care;
  • A guaranty that the impacts caused by the delays in the IT procurement process is fully explained to practices and the impact on practice development during this time is fully acknowledged and reflected in the next procurement process, while the GPC ensures in future no GP practice has to choose an IT system which is in development, or even worse, a pipe dream.

Earlier this year, a Welsh GP admitted that the working hours at his surgery 'stink' while promoting a job vacancy on Twitter

A recent report by Wales Audit Office showed that the implementation of national plans to address pressure in primary care services and guaranty their sustainability has been 'patchy' and 'slow'.

Motion in full

That conference instructs GPC Wales to seek a contractual agreement that requests for urgent home visits after 2pm each working day, if not safe to leave until next day, should be passed either to a commissioned urgent care service or ambulance service for review’.

Readers' comments (24)

  • Interesting proposal. Certainly being called out of the surgery is stressful. I suppose larger practices have a GP on call doing triage and doing visits. In my rural practice we used to be the emergency service , Over the last 25 years the paramedic service replaced this role. We were never paid for rushing out we just did it and the patients were generally sensible. Inner city practice , nursing homes , entitled patients has been the death knell of this sort of service. Perhaps Practice networks may arrange this sort of cover. Retired rural GP

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  • i think home visits are good if apropriate but i pretty much never do any in the afternoon. if they call in then its for the next day. other people phoning for an ammointment have to wait a week why do home visits all have to be done the same day. if it cant wait til tomorrow then by definition they need to be in hospital surely? as said above emergency care is not GP work

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  • There is always a role for home visits but asking GPs to do them during ther lunch isn't sustainable. We also need to tackle the issue of home visits for patients who are not housebound.

    There are better ways of doing this.

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  • surely home visits are one of the things that makes the NHS the 'envy of the world'. But not enough to make other countries copy it

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  • doctordog.

    I wouldn’t miss home visits, whatever their justification.

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  • Stop capition pay per action,then home visits can be valued accordingly.

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  • A sensible suggestion that would have a positive impact on the state of general practice

    In our surgery we would be able to provide more appointments as our duty doctor knows they won’t get a visit

    Instead of chasing after speciality status - the BMA could try and action this

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  • I did home visit once in night as OOH. I stepped on Dog poo in night vision in patient's home and made me feel sick for few days and I have to buy a new shoe.

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  • And I was scratched on my legs with bleeding by a tiny ankle biter dog once in day light during home visit.

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  • Request for home visit last week , "By one o'clock : I've got bowling at two !"
    Er, respectfully : "NO".

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