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Pulse 2019 review: Home truths around GP home visits



Since the very beginnings of the NHS, one of its mainstays has been the local family doctor on-hand to call on the frail and elderly at home.

In bygone halcyon days, a patient wouldn’t even need to be that sick to get a visit from their GP.

Fast-forward to the present day, when surgeries are at breaking point and doctors have neither the time nor the inclination to hold consultations away from the practice.

In this dystopian parallel universe, home visits are viewed as so anachronistic that GP leaders voted in favour of a motion for them to be removed from the core contract.

The shock result saw 54% in favour of ditching home visit and 46% against at the England LMCs conference last month. Such a move would likely have a separate acute service take over urgent visits.

Arguing that GPs should no longer be expected to conduct home visits, Dr Charlotte Alexander, a GP in Surrey, wrote: ‘We all want to be the friendly local GP who knows the whole family, but when was the last time you attended a patient at home that you knew well and genuinely helped them?’

She added that GPs are no longer able to ‘fill the gaps from poor social care and a loss of the family network’.

Opposing the move, Dr Ellie Cannon argued that for the very sickest patients, like those with terminal illness, it’s ‘essential’ that home visits be carried out by their regular GP.

The London-based portfolio GP wrote: ‘There’s a huge amount to gain from seeing a patient at home. More often than not, it’s home visits that prompt me to offer increased support’ – support she wouldn’t have known was needed if someone else had visited the patient.

The outcome of the conference vote means the GPC is now dutybound to try to broker the end of home visits in future contract negotiations. The Committee warned that it was highly unlikely NHS England would play ball.

Whatever those negotiations bring, the vote signals an unprecedented turn-up for the books. It’s the first real acknowledgement that GPs simply can’t cope with the demands they continue to face.

But, as Pulse revealed, it seems that many areas have already acknowledged this trust, bringing in home visiting services to manage demand already.  

Regardless, something has to give – and more GP time caring for more patients isn’t an option.