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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)

  • David Banner

    HMG will never scrap GP visits from our contract. Why would they, it’s fabulous value for (no) money.
    Fortunately we have final say on visits, not the patient.
    Ruthless triaging, dragging into surgery, diverting to another service.....other than palliative care and possibly care homes (at our discretion) visits can be pruned back, mainly by having the spine (and medical defence cover) to say “no”.
    Take back control.
    And as others have said, if an early evening visit cannot wait until the next day, then by definition it needs to go to A&E. It mysteriously becomes less urgent when you tell them that.

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  • Only house visits in Australia are palliative care and nursing homes..... how many of your patients who you do home visits for manage to get to hospital and see the specialist? Ive had requests for house visits, with relatives demanding certain time as they need to get their loved ones out the door to get their hair done (hairdressers often charge for missed appointments..but we dont, go figure) . By and large most requests for house visits are convenience for the patient. Transport issues? Then a driver to collect would be more cost effective than running around the countryside. I think home visits whilst often giving a useful insight to the patient, are just by and large not feasible any more with the demand on General practice.... dropping is a necessity for survival, if the government wants them, they need to be properly remunerated. Perhaps our social prescribing queen can solve the issue with tiddlywinks and origami classes in the patients living room.....

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  • Great idea Curious!
    And maybe the wonderful ‘social prescribing queen’ can do origami with her protocols?

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  • Is it urgent because something serious has just got worse? Fine, go to Casualty or ring an ambulance
    otherwise
    We will see you tomorrow

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