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NICE guidance on GPs identifying patients in cold homes ‘unrealistic’, study finds

NICE guidelines that recommend GPs use existing data to identify patients at risk of ill health from living in cold homes have been labelled ‘unrealistic’ following new research published in the British Journal of General Practice.

The guidance, published in 2015, said that GPs should check at least once a year whether their elderly or vulnerable patients are at risk from living in a cold home, and where needed refer them for help – but it was labelled ‘ludicrous’ by GP leaders.

The recent study – conducted by the University of Bristol, University College London and the University of Birmingham – has concluded that there was ‘no evidence’ to suggest this was possible.

The researchers analysed the records of 34,752 patients who had died between April 2012 and March 2014, across 300 practices.

While they found that every 1°C decrease in temperature was associated with a 1.1% increase in deaths, they were unable to establish any clear groups that were predominantly affected, using the data available to GPs.

According to the office for national statistics, an estimated 34,300 excess winter deaths occurred in the 2016/17 winter period in England and Wales.

Recommendation 4 of the NICE guidelines on excess winter deaths stated that primary health practitioners should ‘use existing data, professional contacts and knowledge to identify people who live in cold or hard-to-heat homes’. It then suggested they include this information in the patient record and use it to assess their risk of ill health from living in a cold home.

But lead researcher Professor Richard Morris said: ‘Primary care data does not routinely include information about whether patients’ homes are cold, so there is no simple way for GPs to identify patients most at risk.

‘Primary health care professionals, especially GPs, may also have little opportunity to visit people’s homes, which means that they are reliant on the patient disclosing a cold home problem or on other professionals sharing that information. NICE’s recommendation therefore appears unrealistic.’

The BJGP study factored in a range of variables, all available in electronic patient records, including age, gender, living situation, location, chronic conditions and other elements such as deprivation, region, emergency hospital admissions within the two years prior to death, and the average house energy efficiency for where they lived. However, despite the large data set no significant associations were found.

Data analyst Dr Peter Tammes said: ‘Our study provides no evidence that GPs can easily identify those at risk during cold periods from data available in existing electronic records. Alternative methods are needed if GPs are to implement the NICE recommendation.’

The study also demonstrated that while exceptionally cold days carry the highest risk, these days are rare and that the largest amount of deaths are own to moderately cold weather.

The paper stated that unless public heath advice changes to include recommendations on moderate weather, ‘little impact will be made on the burden of excess winter mortality’.

Professor Morris stressed the need for change, and said: ‘Given that excess winter mortality persists, it may be more helpful for policy makers and practitioners to focus on improving information sharing between health, social care and the third sector as a way of identifying vulnerable individuals who have poorly heated homes, and on improving the quality of housing, particularly in the private rented sector, where heating and insulation are often poor.’

Under this year’s GP contract, GPs are now obliged to identify patients aged 65 and over who may be living with moderate or severe frailty, and where a patient does not already have an enriched Summary Care Record, they must seek consent to activate it and include relevant information. 

Recommendation 4 of NICE excess winter deaths guidance: Identify people at risk of ill health from living in a cold home

Primary health and home care practitioners should:

· In collaboration with relevant local authority departments, use existing data, professional contacts and knowledge to identify people who live in cold or hard-to-heat homes. This includes people who are particularly vulnerable to the cold;

· Include this information in the person’s records and use it (with their consent) to assess their risk and take action, if necessary;

· Ensure data sharing issues are addressed so that people at risk can be identified.


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