How we made our home visiting service more efficient
The media frenzy over the recent announcement that the LMC had agreed a motion calling for the removal of home visits from the core GP contract was understandable and predictable but, as ever, only half the story.
Headlines such as the Daily Mail’s ‘NHS doctors vote to SCRAP home visits because modern GPs ‘don’t have time to drive from house to house’’ were possibly weighted more acutely than usual due to the impending general election, and so were consequently all the more worrying for patients.
However, we know that the motion didn’t urge the ‘scrapping’ of home visits - it was designed to make such visits much more efficient, clinically targeted and effective, through the creation of a separate acute service for GP surgeries.
We at SSP Health pioneered this way of working back in 2006, with the launch of our Acute Visiting Scheme, the brainchild of our owner and director, Dr Shikha Pitalia.
Dr Pitalia designed the scheme as a dedicated service, fully triaged and audited, when she chaired a commissioning consortium, United League Commissioning, in St Helens and Wigan.
At the time of its launch, with the blessing of the then primary care trust, it was heralded as an ‘innovative approach’ to a growing problem locally - an increase in unscheduled admissions to A&E, 50% of which were regarded as being able to be treated in the community.
Home visits were redesigned in our practices, with all patients requesting one initially given an immediate phone consultation with a GP or nurse, and then that triage process leading to a referral to the scheme or the offer of a routine GP in-practice appointment.
The scheme had a dramatic improvement on efficiency, both on home visits and in the surgery.
Initial findings showed that 43% of people needing a home visit by a ‘scheme doctor’ were seen within 30 minutes, compared with less than 5% previously from the patient’s own GP. The average time spent with such patients also increased from eight to 20 minutes.
The media frenzy over the home visits removal news was only half the story
In practice, access to surgery appointments became easier and we had more ability to ensure patients saw their own doctor due to reduced pressure on GP time.
It also proved beneficial in reducing hospital admissions and re-admissions, saving the trust money. Crucially, 90% of patients who used the service said they were satisfied with the experience.
However, at the time of reorganisation of commissioning in 2013, funding for the AVS service was reallocated – but Dr Pitalia continued it at our Wigan practices at SSP Health’s expense, as she recognised the immense worth of the system.
Dr Pitalia was intent on expanding it, and the AVS has been functioning extremely well across our GP practice locations across the North West.
The AVS was successful in a clutch of awards, and tens of organisations nationwide asked Dr Pitalia to demonstrate how the service worked. She’s been pleased to see that many areas across the country now have a form of her original scheme in place.
The AVS continues to be a valuable feature of our service delivery at SSP Health, although it’s altered to keep pace with changing needs and priorities – for instance, our advanced nurse practitioners now also partake in the service alongside GPs, and paramedics are also involved at our Carlisle practices.
The move to create this type of service on a national level is well-overdue, as we’ve been advocating Dr Pitalia’s blueprint for it as a success story for more than a decade.
Dr Pitalia and SSP Health would gladly share our experience in this with anyone who wants to hear how it works on the ground.
Let’s hope future newspaper headlines on this issue are along the lines of ‘GP home visits better than ever’.
Noeleen Bailey is chief operating officer at SSP Health in Wigan, Greater Manchester