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CAMHS won't see you now

The abolition of practice boundaries is complete twaddle

Home visits: love ‘em or loathe ‘em (I loathe them), they are a part of our everyday workload.

Finish surgery, hungry and generally needing a wee, and head to a visit with a heavy heart. We have started phone triaging, which has helped hugely to cut down on them, but we still have some to do. Some of ours up to 20 mins away, and when we get back to the surgery we face a bunch of paperwork.

And it’s all about to get more fun. With weeks to go, NHS England is still intent on implementing the removal of practice boundaries, but after giving a level of detail that I would expect from my three-year-old if asking her about which mortgage we should get.

There has been no national announcement, some surgeries havent even heard of the plan and those who have, have nothing to work with when deciding to opt in or not.


It think this may be the most extraordinarily ill-thought-through, politically-driven load of utter codswallop that we have been faced with in a long time.

There is talk of payment for GPs coming from a ‘national specification’ but no news about what that means.

We sign up people who we don’t have an obligation to visit we get less money, which is great for commuter areas, but not so good for everyone else.

If a person asks for visit who’s registered in London, but lives near us, we’ll have no notes, and no prior knowledge of patient. Do we visit? And if so, who pays for it - our CCG or their surgery? 

Or do we send them to A&E, whilst at the same time slogging away doing unplanned admission no-care plans for patients who get admitted the next day?

Or, because no one is quite sure, am I to be paid to visit my own patients who live 100 miles away? If so, may I suggest all my patients move to the Maldives - I’ve always wanted to go.

So much could go wrong with the Government’s plans.

GPs of the UK, say no. Please. This is twaddle - and any money will dry up after a year anyway. For once, let’s stand together and refuse en masse.

Dr Stephanie de Giorgio is a GP in Walmer, Kent.

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Readers' comments (17)

  • Whose needs are you serving? GPs' needs or patients' needs.

    Patients abroad are not forced to register with a single (in some areas) practice. Patients abroad have choices and can vote with their feet in order to find quality healthcare. The current monopolistic provision of services is not designed with patients' needs in mind.

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  • Patients abroad pay for home visits or dont get them at all

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  • ^^
    It's not about patients needs, but about patients wants. the service cannot manage to cover patients wants at all times. one patient's wants may well impact on another patient's needs. In reality the vast majority of patients well enough that they would be registered away from their geographic area really shouldn't need a home visit anyway. If this group of patients are genuinely unwell enough to need one they are probably verging on admission as a likely outcome anyway. What we object to is no real planning or realistic provision to allow for this and expecting us to drop our usual caseload who need us and we know, to potentially less safely manage someone we have no idea about, and do so for a pittance. It's grossly unfair to us and to them and is just another indicator of how undervalued we are.

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  • Totally agree with the article. Patients' demands are rising exponentially, not helped at all by the half baked ill thought out promises all the political parties make to get votes! I do not have 5 minutes in my day sometimes to go have a wee, let alone visit someone 40 miles away. Gps are expected to do more and more in their working day and quite often 12 hour days aren't enough to finish everything that needs doing. This is not about monopolising the system, it's about practicality and sensible care. Let's ask the politicians at Westminister to promise to visit people in Newcastle as a given... Everyday.... Then ask primary care to abolish boundaries! Total load of crap from the government yet again!

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  • Essentially this policy is brain-damaged. At best, the proponents of this policy are well-meaning but incompetent; but the likely explanation is that the real driver here is to change the model of general practice in England so that large for-profit organisations can run practices without the constraints of geography. They will be the winners. There will be mobile, articulate people who will benefit.

    In Tower Hamlets we are sticking with geographically-based general practice. Here is what we are telling our patients:

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  • Ill thought out crap....
    If someone not registered with my practice requests home visit - my answer will be sorry we don't have capacity to take temporary residents . Try walk in / a/e or ring the MP ......

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  • With due respect, other healthcare professionals should keep out of this because they have no idea what it means to home visit

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  • alleged'other health care professional' is an ignorant troll.
    agree with article
    shallow stupid vote catching idiocy for selfish self entitled loud middle class

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  • Stupid idea...the NHS is a cash limited health service ...people's 'wants' are almost limitless, but you simply can't have everything you 'want' unless you can actually pay for it. For the providers of care this is a logistical nightmare that will damage continuity of care and put patients at risk...a stupid stupid stupid idea...and as such pretty much guaranteed to become reality

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  • Took Early Retirement

    I agree with the general drift of the article.

    However, oddly, I didn't mind doing 2-3 visits a day. They were generally reasonable (in recent years*) and broke up the day a bit.

    2 things that helped me:-

    1. I went for a pee at the end of surgery
    2. We got a VPN system so we could log on to the surgery computer form home. BRILL! Because this meant I could do "paperwork" as we still called it, on the kitchen table at HOME, at a time that suited me. Also I would write up the visits then. This had the added advantage that one was not continually interrupted by staff members knocking on the door to sign prescriptions or deal with all the endless minor items that they would dump on one if one were there.

    * 15 years ago they weren't. They were generated by the generation who were young adults in the early days of the NHS whose response to almost any illness was "call out the doctor". I used to rarely do less than 5 a day. 8-10 on Mondays and my record, for a weekday, was 21 AND 2 full surgeries. (About 25 years ago on a winter day.) However, there were far less phone calls.

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  • If you 'loathe them so much no doubt your attitude will not be therapeutic towards those who you have the priveledge of calling on. Given the choice do you think they all want health visits in their homes? Presumably you knew the score when you took the job which gives you the flexibility many would wish for. For goodness sake anon 10 29th oct above try to relaise that insults do'nt change anything they just give the rest of us a laugh try to instead understand that GPs are only part of the team and 'other healthcare professionals' make many more home visits than GPs.

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  • this is yet another policy to suit London commuters being forced over the entire country where it is not appropriate. The London centric governance of this country is crippling us.

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  • Took Early Retirement

    Yes, 10.51 I expect DNs do a lot more, but they do NOT do 2 surgery sessions in a day nor all the admin that goes with running a practice.

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  • I think twaddle is a very generous description. And I think hat describing the level of detail as even approaching that of a three year old is positively gushing with generosity.

    The serial demands made on General Practice, principally in the name of patient choice are removing that very thing.

    Soon you can have access to General Practice surgeries whenever you want. But the inconvenient truth is that there will be no GPs for patients to see, less choice of who you want to see and less continuity. Keep on slamming and damning us because if you don't give us a break we will do just that...break.

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  • Vinci Ho

    Sorry. Excuse me to my English . I originally thought twaddle was a 'new' swear word which does sound like the other one anyway(you know what I mean?). Could be a very powerful headline !😝😚😁
    Great article, well done 👍👍👍👍

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  • alleged other healthcare professional again shows he hasn't the first clue and doesn't see that practice boundaries are for good reasons of time efficiency and good patient care.
    please talk about something you understand in future.

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  • I feel the big problem is that in areas with commuters they will register near work and been seen rarely for easy stuff. Resources will follow them to the place they work. But when they really ill they will then expect a GP where they live to provide often a short period of highly intensive input especially if it is palliative care. But there has been no resources to provide said GP for several years until suddenly it is needed. And if they re register for 3 months the GP will likely only be paid £20 for multiple visits and lots of work.
    It is a bit like going to tescos 20 miles away for years in your car, then losing your license because of ill health and finding the small shops within walking distance are not there.
    It can only work if GP care is done on an item of service basis. So much for an appt and so much for a visit. But the government will not go for this as it transfers the demand financial risk on to them rather than GPs who are carrying that risk essentially on a fixed price all you can eat buffet.

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