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Visitors from the past

I realise it’s easy to just snipe from the medicopolitical sidelines, so I will. Because Kent LMC’s conference motion to contractually scrap home visits makes me wonder if I just dreamt the last 15 years, and the 2004 and 2019 contracts in particular.

If we just time-hop to 2004 for a second (Tony Blair PM/Shipman dead/Arsenal invincible, if you need prompts) then we could take a look at a contract which makes it clear that the venue for a patient’s consultation is our choice, not the patient’s.

This contractually protected us from the then-standard ‘we haven’t got a car’/‘can’t afford a taxi’/‘not coming out in this weather’/‘would rather carry on watching Jeremy Kyle’ home visit demand.

True, the ‘too ill to move’ patient was a judgement call, but my judgement is that any patient that sick needs an ambulance, not me.

Which leaves us with visiting only the bedbound or palliative, which Kent LMC remain happy with.

Any patient that sick needs an ambulance, not me

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In other words, with the blustering and media-fodder motion to ‘remove the anachronism of home visits from core contract work’, it feels like they’ve neatly suggested an answer to a problem that was solved 15 years ago – obscuring what might be the real point, that these requests should get diverted before they even darken my in-tray.

And it may be even worse than that. If we scoot from 2004 to now, we’ll notice that the 2019 contract a) lasts five years and b) makes it clear that the NHS money tree has been shaken bare, so there is no additional dosh until 2024/5.

That means that there is no way a national visiting service is going to get as much as a flashing blue light, particularly given that the contract’s additional role reimbursement scheme already forces on us spare paramedics, which represents a subsidised visiting service if that’s what you really want.

So as far as motions go, this one seems a bit constipated to me. It’s almost as if medicopolitics is full of muddled thinking, futile indignation and hot air.

Ha, they’ll be suggesting scrapping the entire PCN contract next!

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield