What is the future of the GP home visit?

‘GPs set to ditch home visits’, screamed the national press headlines following an explosive England LMCs conference in November.

Local GP leaders narrowly voted through a motion calling for home visits to be removed from core contract work. They instructed the BMA GP Committee to negotiate a separate acute service to cover home visits after concluding that, in a climate where the average GP works 11-hour days, their time is better used seeing more patients in surgery.

Immediately, health secretary Matt Hancock ruled this out. But, in reality, many parts of England are already commissioning home-visiting services separate to GP practices. Here, we look at a selection of these.

 

Portsmouth

How does it work?

It is delivered by the local GP federation Portsmouth Primary Care Alliance and is available for patients registered with practices in the federation. Requests are pre-triaged by a GP, and appropriate requests are passed onto GPs that staff the service. GPs either work shifts or conduct home visits full time. The service operates for a full day, from 8am to 6.30pm, and largely consists of visits done on the day, but there is the ability to do follow-up visits.

What kind of visits does the service cover?

All home visits apart from those to end-of-life patients, patients under 18, and those with mental health issues.

What is the benefit?

Wessex LMCs chief executive Dr Nigel Watson says: ‘It benefits the practice by taking some of the visits that aren’t end-of-life care. Hospitals benefit as there are people visiting earlier so you haven’t got a bulge of patients towards the end of the day.

‘The GPs running the service also benefit. Some older GPs don’t want the hassle of partnership but still want to do clinical work. And early career GPs can do family-friendly hours.’

 

Tyneside

How does it work?

NHS Newcastle Gateshead CCG commissions an urgent care team service that does some acute visits. Any visit request is triaged over the phone by the duty GP and, on some days, practices will have no home visits at all, says Newcastle GP Dr Paul Evans.

What kind of visits does the service cover?

Anyone apart from the elderly and bedbound patients.

What is the benefit?

Dr Evans says: ‘Our practice doesn’t do many visits because we have basically trained our patients as to what is an appropriate visit and what’s not. We visit the bedbound and the end-of-life patients.

‘We don’t expect other services to take on the end-of-life visiting for us, we do those ourselves, but we use the North Staffordshire LMC guidelines (see below) on visiting. That is our practice policy and has been for some years. Therefore, our visit rate is low. We probably average less than one visit per GP per week.’

 

North Staffordshire LMC guidelines

Who delivers it?

The LMC set up home-visiting guidelines around 15 years ago, updated last year, to help GP practices decide what is an appropriate home visit. The CCG commissions an acute home-visiting service, using paramedics and dedicated GPs.

How does it work?

The guidelines outline a home-visit request pathway to determine if a patient is indicating a life-threatening condition and needs 999, or if they can be seen in the surgery. They also say care home visits should not be treated differently to requests by individuals. It is not the practice’s responsibility to arrange transport or visit a patient who has difficulty arranging transport.

What kind of visits do practices conduct?

GPs do visits that make ‘clinical sense’, such as to bedbound or terminally ill patients. Practices can refuse visits that involve common problems or intimate examinations, or visits to children where the parent refuses to attend surgery.

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