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Independents' Day

Your first... home visit

GPs are more reluctant to do home visits nowadays but patients still demand them. Dr Melanie Wynne-Jones discusses

GPs are more reluctant to do home visits nowadays but patients still demand them. Dr Melanie Wynne-Jones discusses

Home visits are becoming rarer, even though patients still expect them. Although most GPs are happy to visit the terminally ill and truly housebound, they are increasingly wary of consulting without full surgery facilities, and view travelling time as wasted.

Occasionally, however, visits can offer telling insights into patients' and relatives' behaviour, home circumstances and patients' ability to self-care.

Nowadays most visit requests are telephone triaged. This:

  • allows you to get a clearer picture of what the patient (or relative) wants or needs
  • assesses whether visiting is the most appropriate response (if in doubt, go anyway)
  • alerts you that you may need to chase up a hospital letter or obtain background information from a colleague
  • identifies possible risks such as a potentially violent patient or relative, or the need for a chaperone
  • enables visits to be scheduled for a convenient time, for example so that a relative can be present (with the patient's consent)
  • allows you to make any necessary arrangements, for example if a patient needs to be sectioned under the Mental Health Act

You will need:

  • the patient's computer summary and/or Lloyd George packet plus any relevant scanned letters
  • medical equipment
  • notepaper and prescription pad
  • emergency drugs
  • useful phone numbers (including the patient's)
  • your mobile
  • an up-to-date street map (and torch if it's dark) – ask staff or the patient for explicit directions as some houses and flats are difficult to locate and poorly numbered or very remote. If in doubt, ask for someone to be outside to meet you

Tell staff where you are going and when you expect to be back. Always be alert to potential risks – vicious dogs, angry, agitated or inebriated patients or their relatives. Park where you should be safe, avoid using an obviously 'medical' bag and wear shoes you can run in.

Even if you are unhappy about visiting, always approach the consultation with an open mind and a professional manner, otherwise you may make a mistake or provoke a complaint. Be careful about any examination that requires the patient to undress – postpone it, or get a chaperone if you can (but asking a relative or friend could breach confidentiality). Post-Shipman, think carefully before personally administering an oral or parenteral drug; seek informed consent from the patient (and relatives if appropriate) and keep detailed records.

Prescribing is best done on the practice computer to double-check allergy or interactions, and to save duplication. Jot down reminders, so that you also remember to take any promised action, such as dictating a referral, and can complete the computer record when you get back.

Finally, reflect on the reasons for the visit, how the consultation differed from a surgery one, and whether visiting was correct in the circumstances. If you feel the request was inappropriate, discuss this with your trainer before saying anything.

Melanie Wynne-Jones is a GP in Marple, Cheshire

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