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Are home visits a waste of time?

Home visits have no place in modern medicine, argues Dr Shaba Nabi, whereas Dr Justine Hall believes they are still an important part of holistic care

Dr Shaba Nabi

YES. They are an anachronism in modern medicine

As a GP trainer and educator, I should extol the virtues of the home visit; an opportunity to scrutinise our species in their own habitat. However, except when tending to the dying in their last few months, I feel visits are a total waste of time.

In the days before satnav, dead-ends and one-way streets would keep me driving around for hours trying to find a house. Nowadays, there is the additional headache of residents-only parking. I either risk a parking ticket or put a huge notice in my car announcing I am the visiting doctor.

Safety is an issue, too. Hundreds of hours are spent preparing for practice CQC inspections, yet no one is interested in our health and safety in someone else’s home. Hygiene probably bothers me more than anything else. Forget a bit of dust or a cluttered house – we’ve all visited people lying in their own faeces, while trying to dodge the animal excrement dotted around the carpet. And speaking of pets, the sound of a dog barking through the letterbox always sends shivers down my spine.

These may seem like superficial inconveniences, but not when you consider that home consultations are rarely of clinical benefit. Examinations can be impossible to do properly. As medical students, we were indoctrinated to examine patients from their right-hand side. Home visits allow us no such luxury and we are lucky if the patient is even lying down. An intimate examination can turn into a Pythonesque sketch; I recall once bringing in my head torch to perform a speculum examination.

Home consultations are rarely of clinical benefit

Home visits are also the means by which GPs become the dumping ground for any number of issues. I have been asked to certify dead bodies, to assess someone’s safety in their home and even to measure a patient for a wheelchair.

And that’s if the patient even answers the door. Are they a) at the hairdresser; b) still on their way to the door; c) lying on the floor with a broken hip; or d) dead? Will tomorrow’s Daily Fail headlines say ‘GP broke down door while Gladys was taking 40 winks’ or ‘GP left dead patient’s body to decompose for two weeks’?

I feel home visits need to be consigned to Dr Finlay’s Casebook – a fictional walk down memory lane, with no relevance in today’s climate of litigation.

Dr Shaba Nabi is a GP trainer in Bristol

 

Dr Justine Hall

NO. Seeing patients at home can be invaluable

Let’s face it, home visits are time consuming. In rural areas, it can mean a 30-minute drive each way. Even in urban areas, traffic and parking problems mean visits are never straightforward. Potentially hours of doctor time can be taken up just driving around. It is easy to say our time is better spent in the surgery and that dedicated visiting doctors or paramedics are better placed to do this work.

However, home visits do have benefits for both GPs and patients. First, leaving aside the patient element, it’s worth reflecting on why we are so stressed and at risk of burnout. It’s actually not bad for us occasionally to step away from the consulting room and go for a drive, listening to the radio, a podcast for CPD or relaxing music on the way. You might even stop at a shop and buy lunch. We can use this downtime and shouldn’t regard the journey as a chore.

Home visits also increase our awareness of our patients’ situations, helping to improve how we care for them holistically and even preventing future unnecessary appointments. I was reminded of this recently when I visited an elderly woman receiving palliative care. I got there only to learn her visit was a mistake; she had been seen the day before and should have been scheduled for review a week later. On realising this, I prickled with annoyance.

The journey needn't be a chore; we can use the downtime

But then I stopped myself. I sat down. Her cat sat on me. We chatted about how she and her cat go everywhere together, which is why she can’t move to a care home or hospice. We talked for about 10 minutes while I stroked the cat. Her daughter joined us and I explained we’d be back the following week. I didn’t particularly want to go as I was comfortable having a chat with her, and so was the cat.

Often the information we glean from visits is invaluable. The medication given the previous week that’s still in the packet; the living conditions; the supposed non-smoker’s ashtray full of cigarette ends; the other family members; the temperature, the cleanliness, the security.

I don’t regard visits as a waste of time. I try to make the most of the time away from the computer and the opportunity to speak to people in their own environment. That way we can understand their needs and help them accordingly.

Dr Justine Hall is a GP in Guildford, Surrey 

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Readers' comments (25)

  • doctordog.

    Can a doctor visit my mum please who has just arrived back from a cruise and run out of tablets?
    Can you let me know what time the doctor will be calling, as I’ve got to nip out to the shop?
    Aren’t you obliged to visit all elderly people every 3 months?
    Can the doctor pop in on his way home?
    My dad had a fall last week and I would like him checking over.
    Etc etc.
    It always amazes who you see shopping in the local supermarket, especially those that had a home visit yesterday.

    I must stop whingeing.

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  • As usual both sides have correct and incorrect opinions. For a start, Shaba, Dr.Finlays Casebook wasn’t totally fictional but a semi autobiographical story about the author A J Cronin who was a doctor pre NHS before he became so disillusioned with medicine that he left to become a successful author. Do you recognise that decision which is prophetic relating to the state of NHS medicine today.
    In the remote mountain practice which ran single handed for 33years then home visits were both necessary and useful. The 200 sq.miles that I covered had no public transport available and elderly patients had no way of getting to the central surgery especially in winter when we could be under a few feet of snow for extended periods even up to May.
    And yes I practiced in UK! However with the time constraints caused by DOH, QOF etc.it did become impossible for me to do 10 home visits a day as well as surgeries, emergencies, minor surgery.
    So the answer to whether home visits are a waste of time is both yes they are and no they’re not.

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  • If home visits are so important, they need to be properly valued and resourced. If I was given one hour of uninterrupted allocated time per visit (taken from one hour of surgery time) and/or appropriate remuneration, I might feel that home visits were worthwhile. There is a definite cohort of patients who would find a way to get themselves or their relative to the surgery if they had to pay even a nominal fee.
    In these days of relentlessness demands, unsustainable workload and limited resources, we can't justify the luxury of home visits.

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  • Triage viscously
    Use other HCPs / VCFS as much as possible
    Visit only when absolutely necessary
    And remember visits don't have to be done the same day

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  • Actually some home visits do have to be done the same day and in a minority of requests immediately but that is where appropriate triage would be helpful;or is that an oxymoron?)

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  • No,not a waste of time, but no longer should be seen a safe a part of personal lists and continuity of care, by which I mean that you can't expect to have wall to wall appointments by as many doctors that are available and home visits by your chosen doctor, and the right to phone calls at your convenience by a doctor that is a) still working and b) prepared to go for days without food. We changed to 'visit doc' about 6 months ago - no not a 3rd party private concern, just one of us doing all the visits. Patients grumbled at first, but really they can't have the benefit of a home visit, AND have their 'own' doctor. If it really needs a home visit, then have the doctor that arrives and don't grumble, and if you want 'your' doctor then make an appointment, or pay a private doctor. The NHS can't provide everything all the time.

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  • I agree with Dr.Shaba Nabi, HV is a waste of time. IF somebody is so ill to make it to come then they need ambulance, if they can then they should come to the practice. Also we should think of next generation who think every things would be like this for ever when they are a bit older in this climate of pressurised heathen service. I went to a HV , a young man unnecessarily called for HV and I don't know why he could not come to the practice.

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  • Shabi has my vote...HVs are a complete waste of a doctors time....I can see 4-5 patients at surgery for the time it takes to do a single HV with round trip travelling

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  • I agree with many comments- a waste of time but only in the way so much of what we do is a waste of time. Home visits just take longer and bring other annoyances with them. Patients should only be able to access them if put on a register like the gold standard framework. Otherwise if you’re too ill to come in you’re too ill for a GP.

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  • General Practice used to be about long term relationships and continuity. We weren't specialists is some ivory tower, but lived within our community and shared experiences.My wife was A Marie Curie nurse. I suspect new GPs would wish this was the same. What better way to build a relationship than visiting an old immobile or palliative patient, and seeing where and how they live. I visited a lovely lady in her 30s dying from metastatic breast cancer, with two young children, who lived 10 miles away, and I felt humbled. It seems to me that General Practice is dying without a fight from its 'beloved' leaders !!

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