I have finally written a thing I never thought I would need: a home visiting protocol. Why? Because the thing I loved the most as a medical student has turned into a pet hate.
The joy used to be that you could go to see people just because they were lonely, or to check up on them before they became ill. (Isn’t that called preventive medicine?). You also had colleagues to work with in the community – the district nurses were easy to chat to because they were in the surgery too. You didn’t spend half an hour trying to find which form to fill in because there weren’t any forms – what nirvana!
I recall fondly my first GP attachment at medical school. It was in a small, terribly well-to-do practice somewhere in rural Nottinghamshire and I was bored to tears. The brief respites were the home visits.
The GP was a ‘proper’ doctor – male, mid-50s, white, nice two-seater sports car. He ticked all the boxes, and arrived in his impeccable suit with leather bag in hand.
Home visits gave me a way to nose round other peoples’ homes without being arrested
I trailed behind looking awkward in my one pair of smart trousers from New Look and a creased jumper rescued from the wash that morning.
He was greeted like an old friend, offered tea, biscuits, and not infrequently lunch, by all the patients. There was little medicine, and a lot of chatting. It was fascinating in a way that the surgery wasn’t; I had found a legitimate route to nosing around other people’s homes without being arrested. General practice had it nailed.
But at some point, time pressures grew and only poorly people got home visits. Even then not all of them were acutely ill, some were still chronic disease patients or the frail elderly. Now workload is so bad I have time for one, maybe two visits max.
Yet home visit requests now flood in from other health providers wanting us to take up their slack. Why am I being called to review the palliative patient in the nursing home? Has anything changed, are they distressed, is the family worried? ‘No doctor, but we weren’t sure if they were palliative or about to die…’ And it just keeps increasing: discharged from hospital – home visit; rung 111 – home visit; can’t get a taxi – home visit.
Perhaps it is that the number of cups of tea I’m offered has fallen as demand has risen, but there seems to be no appreciation from the system, or from the patients, about how this once-cherished service is now being abused.
So I have written the protocol to try to educate patients about the harsh reality of general practice in 2018. Will it solve the problem for me? No chance, because again it’s about me having to say ‘no’ to patients.
I didn’t become a GP to ration care – we’re a band of eager puppies who want everyone to like us.
And let’s be honest, this is another nail in the coffin of the ‘jewel in the crown’ of the NHS (along with the three-week waits and ever-decreasing staff). When the NHS dissolves into private practice, maybe I’ll regain my joy about home visits.
Perhaps I need the awfully nice folks to fawn over me with tea and biscuits to feel valued. Or maybe I just need time to do my job – now there’s a radical thought.
Dr Zoe Norris is a GP in Hull