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GP leaders to call for removal of home visits from contract



English GP leaders are calling for a removal of home visits from the core contract work because GPs no longer have the capacity to carry them out.

LMC leaders will vote on a motion at the England LMCs conference on 22 November, calling for the GP Committee England to negotiate a change.

Kent LMC, which has proposed the motion, will debate on whether to instruct the GPC to negotiate a separate acute service for urgent home visits.

The LMC says that GPs can no longer carry out home visits as part of their current core work.

The current GP contract outlines other healthcare professionals such as physician associates and advanced paramedic practitioners to undertake home visits once they are recruited.

GPs in the area have sympathised with the motion, including Kent dispensing GP Dr Mark Ironmonger.

Kent locum GP Dr Andy Parkin, who put forward the motion said the reason was to ‘remove the expectation’ that home visits are part of general practice.

He said: ‘Even though I don’t tend to do home visits as they’re not part of my terms and conditions, I will do them if needed and they’re paid for.

‘The main thing is the workload and demand on time in general practice. It’s not to remove the ability to do home visits if GPs want to. If there are truly house-bound patients or palliative care patients, I think GPs should still be able to do that.

‘The key thing is to remove the expectation that home visits are a part of general practice. They are the most time-consuming part of the job; they are one of the most litigious parts of the job. Even trying to triage visits causes a lot of aggravation from patients who ring up and want a visit and don’t need a home visit.’

He added that not only is the difficulty from rising GP workload but also from widening GP footprint.

He said: ‘With the GP footprint getting wider from PCNs and mergers, visits can be a long way away. They can take an hour to go and get back. There isn’t that free time in general practice anymore.’

He continued: ‘In Kent, there is a home visiting service run by paramedics and nurses. Urgent visits requests are passed over to them but they have a limited capacity. Where there are seven visit requests, only two are passed over which still leaves five for us.’

Professor Helen Stokes-Lampard, chair of the RCGP, said: ‘Home visits can be very time consuming and take the GP away from the surgery when they could be seeing other patients, and where there are far better facilities to properly assess patients.

‘But for some of our more complex and vulnerable patients, home visits are an invaluable, and often the only, means of seeing their GP.

‘We are very supportive of proposals to train other members of the GP team such as physician associates and advanced paramedics to carry out home visits as appropriate, but they are not a substitute for GPs and it is vital that patients who need the skills of a GP are able to access them.’

Welsh GPs recently called for afternoon home visits to be passed onto ambulance services at the Wales LMCs conference over the weekend.

But delegates at the conference voted against motion, which argued that the Welsh GPC should negotiate an amendment to the GP contract so that urgent home visits after 2pm would be passed on the urgent care services.

Motion in full:

KENT: That conference believes that GPs no longer have the capacity to offer home visits and instructs the GPC England to:

i. remove the anachronism of home visits from core contract work

ii. negotiate a separate acute service for urgent visits

iii. demand any change in service is widely advertised to patients.