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What is the future of the GP home visit?

Anviksha Patel looks at how many areas are already commissioning home-visiting services separate from the GP practice

‘GPs set to ditch home visits’, screamed the national press headlines following an explosive England LMCs conference in November.

Local GP leaders narrowly voted through a motion calling for home visits to be removed from core contract work. They instructed the BMA GP Committee to negotiate a separate acute service to cover home visits after concluding that, in a climate where the average GP works 11-hour days, their time is better used seeing more patients in surgery.

Immediately, health secretary Matt Hancock ruled this out. But, in reality, many parts of England are already commissioning home-visiting services separate to GP practices. Here, we look at a selection of these.

Portsmouth

How does it work?

It is delivered by the local GP federation Portsmouth Primary Care Alliance and is available for patients registered with practices in the federation. Requests are pre-triaged by a GP, and appropriate requests are passed onto GPs that staff the service. GPs either work shifts or conduct home visits full time. The service operates for a full day, from 8am to 6.30pm, and largely consists of visits done on the day, but there is the ability to do follow-up visits.

What kind of visits does the service cover?

All home visits apart from those to end-of-life patients, patients under 18, and those with mental health issues.

What is the benefit?

Wessex LMCs chief executive Dr Nigel Watson says: ‘It benefits the practice by taking some of the visits that aren’t end-of-life care. Hospitals benefit as there are people visiting earlier so you haven’t got a bulge of patients towards the end of the day.

‘The GPs running the service also benefit. Some older GPs don’t want the hassle of partnership but still want to do clinical work. And early career GPs can do family-friendly hours.’

 

Tyneside

How does it work?

NHS Newcastle Gateshead CCG commissions an urgent care team service that does some acute visits. Any visit request is triaged over the phone by the duty GP and, on some days, practices will have no home visits at all, says Newcastle GP Dr Paul Evans.

What kind of visits does the service cover?

Anyone apart from the elderly and bedbound patients.

What is the benefit?

Dr Evans says: ‘Our practice doesn’t do many visits because we have basically trained our patients as to what is an appropriate visit and what’s not. We visit the bedbound and the end-of-life patients.

‘We don’t expect other services to take on the end-of-life visiting for us, we do those ourselves, but we use the North Staffordshire LMC guidelines (see below) on visiting. That is our practice policy and has been for some years. Therefore, our visit rate is low. We probably average less than one visit per GP per week.’

North Staffordshire LMC guidelines

Who delivers it?

The LMC set up home-visiting guidelines around 15 years ago, updated last year, to help GP practices decide what is an appropriate home visit. The CCG commissions an acute home-visiting service, using paramedics and dedicated GPs.

How does it work?

The guidelines outline a home-visit request pathway to determine if a patient is indicating a life-threatening condition and needs 999, or if they can be seen in the surgery. They also say care home visits should not be treated differently to requests by individuals. It is not the practice’s responsibility to arrange transport or visit a patient who has difficulty arranging transport.

What kind of visits do practices conduct?

GPs do visits that make ‘clinical sense’, such as to bedbound or terminally ill patients. Practices can refuse visits that involve common problems or intimate examinations, or visits to children where the parent refuses to attend surgery.

 

Readers' comments (18)

  • My Mother-in-Law who had a stroke four years ago had two home visits for a cough last week, these were arranged by her carer and my M-in-L was late for a luncheon due to one and rescheduled her hair appointment for the other. She books taxis for travel but feels she deserves house calls, I remember why I left GP for a different job.

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  • Cobblers

    Errrr. The North Staffs Guidelines were being used by the OOH Co-ops and the Co-ops were disbanded some 15 years ago.

    This latest version is Revision 5, (01.11.19) and 2012 presumably was Revision 4.

    Come on Pulse basic fact checking.

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  • Thanks for pointing this out - amendment has been made

  • Cobblers

    8:25pm why does your MiL feel she 'deserves' a house call? Yet those same days she gets that privilege she goes to a luncheon or gets her hair done.

    A quiet word in her shell like is needed. Or maybe a word in the shell like of the cardie GP? Or both.

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  • Took Early Retirement

    I think he/she was illustrating the problem.

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  • Teleport. Definitely teleport.

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  • Bob Hodges

    The lady in that picture doesn't look house bound - I hope she's not the subject of the home visit herself.

    I apologise profusely if in fact her husband is terminally ill upstairs in bed. Bless her.

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  • @cobblers.
    I was simply illustrating the problem, my M-in-L believes she deserves home visits because she is elderly and rich, the belief is further compounded by her carer who calls the surgery at the drop of a hat to further ingratiate herself with my M-in-L and appear really caring. The solution in my view is a charge of 30-50 pounds and allowing GPs to say no. Good luck.

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  • Cobblers

    HFY 9:25am Yes I understand that but it was a scenario that actually occurred was it not?

    In my early days I met this mind set too. An old biddy who was negotiating with me as to the time I would call as she had two 'appointments' with a gap in between for me at home.

    Needless to say she came to the surgery somewhat grumpy.

    We are singing from the same hymn sheet. :-)

    Charging is one option. No home visits would be better.

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  • I visited an elderly lady for ongoing issue yesterday evening at 6pm as couldn't come out before. She walked to the door and asked me to leave as I was late.

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  • MR @ 1:23pm

    The relationship between this elderly lady patient and your GP practice has obviously broken down. She no longer demonstrates any respect for your professionalism or time and is openly rude and inappropriately bossy. You (and your mates) know what to do?

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