NHS England has asked GPs to do home visits throughout the morning to avoid ‘surges’ of patients arriving at A&E, with GPs saying the idea ‘is unrealistic’.
In a letter to CCGs, NHS England directors have asked GPs to ‘have plans in place to run visits through out the morning, as opposed to batching them’ in an effort to reduce ambulance handover delays.
Pulse also understands that, in a separate scheme, three CCGs in one area of England are offering practices 75p per patient to create a plan that will allow GPs to visit patients from 8:30am over winter.
NHS England’s letter states that patients are arriving to hospital ‘in surges as a result of all domiciliary visits, and thus conveyance requests, taking place after morning surgeries’.
The NHS England directors say this is leading to ambulance services struggling to unload patients into A&E ‘in a timely manner’.
The letter adds: ‘CCGs and GPs should work together with the CCG being responsible for overseeing the daily schedule of GP visits from all surgeries to ensure that large numbers of ambulances do not arrive together.’
Professor Jonathan Benger, NHS England’s national clinical director for urgent care, told Pulse that earlier home visits will not become mandatory for GPs but is instead ‘asking GPs to help us with this particular problem’.
He said: ‘If it’s possible for GPs to rearrange some of their day so that patients who need admission can be identified at an earlier stage, then that’s helpful to the system as a whole.’
He said that doing home visits after morning surgery creates a very high demand on ambulance services ‘at a particular point in the day’, which ‘puts a challenge on the system in terms of how the A&E can get the capacity to unload those ambulances’.
Professor Benger also said that NHS England has no plans to incentivise earlier home visiting but added that ‘it’s very helpful if commissioners locally can find ways of supporting GPs’ to do this.
At the same time, three CCGs in Worcestershire are offering practices 75p per patient to create a plan that will allow GPs to visit patients from 8:30am over winter.
The scheme covering NHS Redditch and Bromsgrove CCG, NHS South Worcestershire CCG and NHS Wyre Forest CCG aims to reduce pressures by sending patients to hospital, if necessary, before 2pm, after which time patients arriving at hospital are usually admitted.
Dr Clare Marley, chair for NHS Wyre Forest CCG, said the CCGs have secured £450,000 in ’winter funding that historically would have gone into hospital based capacity to pay practices’ to plan their day to allow for earlier visiting.
She added some practices in the area are already offering early home visits with the winter initiative expanding the scheme, which has shown ‘some impressive results’ in reducing demand on hospitals.
However, Dr Peter Swinyard, chair of the Family Doctor Association, said planning to do early home visits ‘just doesn’t work’, with visits done on the day of request making planning difficult.
He said: ‘The problem is that people are not very good at ringing requesting home visits earlier in the morning and visit requests come in throughout the day, however much you tell patients that you would like to have them in by 10 o’clock or 11 o’clock in the morning.’
He added: ‘It’s a little bit bizarre to say, well can’t you go and do your visits at 10 o’clock in the morning, when the patients aren’t even asking for them until 11 o’clock. It’s unrealistic.’
Last November, Pulse reported that NHS England recommended CCGs fund a local enhanced service to have GPs do more urgent home visits to reduce A&E pressures.
Changes to GP home visiting
Several regions have been changing their approach to GP home visiting in recent months.
NHS Bath and North East Somerset CCG implemented a similar scheme to the one in Worcestershire, allowing patients to request an early morning home visit, either by a GP, a nurse practitioner or a specialist paramedic to reduce unnecessary overnight hospital admissions.
Meanwhile, in South Hampshire GPs are able to refer all of their home visits to a dedicated team that visits early in the day, allowing GPs to offer 202 more appointments each month.
However, in Manchester, paramedics have taken on nearly all home visits, allowing GPs to offer half-hour appointments.