Home visits are at the discretion of your doctor. Please do not ask your doctor to call unless the patient is genuinely too ill to come to the surgery. A rash or a temperature does not prevent patients coming to the surgery and will not endanger others. Simply tell the receptionist on arrival.
Where the condition of the patient does require a home visit, please try to let us know before 11:00 in the morning.
HOME VISIT POLICY SAXONBURY HOUSE MEDICAL GROUP OCTOBER 2019
Home visiting is a traditional part of British general practice but in view of the excessive and increasing work load of GPs, it is sensible to review the home visit policy of the practice to ensure that precious NHS resources are used wisely.
This mode of consultation takes a disproportionate amount of time and is not necessarily the optimum or safest environment in which to consult. In the time it takes to carry out one home visit several surgery consultations can take place. With an ageing population who are experiencing increasing levels of frailty and multi-morbidity, it is likely that the number of requests for home visits may increase. This is clearly unsustainable and will have a potential detrimental effect on the remaining practice population. The patient’s home is rarely the ideal place for a consultation as there may be problems with poor lighting, unhygienic conditions, soft beds etc. making an examination difficult. The safest environment to carry out a consultation is in the GP surgery where there is access to the latest medical and diagnostic equipment.
There are potential safety factors for the visiting practitioner who will usually undertake visits alone. In addition, the increased work load generated by carrying out numerous home visits has an adverse effect on the morale, potential recruitment and retention of GPs as there is less time to complete the ever increasing administrative demands of the job in normal working hours.
The GMS regulations Schedule 6 Regulation 26 Part 1 states that it is the doctor’s decision, based on the ‘doctor’s reasonable opinion’, whether the patient should attend the surgery or be visited at home. Therefore, it is the clinician’s decision to determine where it is most appropriate to see the patient. As it important to assess patients in the safest possible environment, this is most likely to be in the surgery and not the patient’s home. In addition, there is nothing in the regulations that prevents a doctor from referring a patient directly to hospital without seeing them first providing ‘the medical condition of the patient makes that course of action appropriate’.
It is important to note that GPs cannot provide an emergency response service along the lines of the ambulance or police service. The manpower and infrastructure of general practice is not set up for this method of working and so the clinician should advise the patient or carer of the most appropriate service to access in these instances such as in cases of chest pain, stroke and severe breathing difficulties.
Deciding which patients require a home visit
In general, if a patient is able to attend an appointment in another setting such as a hospital appointment, then it is reasonable for them to attend an appointment at the GP surgery. This also applies to patients in residential care. It is not appropriate for the practice to perform home visits for the convenience of patients who have difficulty in arranging transport to travel to the surgery. It is not the responsibility of the practice to arrange transport and patients should seek help from relatives, friends or taxi services.
Unwell children will almost always be able to travel to the surgery by car. Children with a fever will not be made worse by travelling and it usually is in the best interests of the child to attend the surgery where they can be properly assessed and treated.
There are situations where a home visit will be the most appropriate way to assess a patient;
- Patients who are terminally ill
- Bed-bound patients
- Patients severely ill in bed
There are also occasions when a home visit may be appropriate for example, patients whose condition may deteriorate when they are required to travel and also for those patients for whom it is clinically relevant to assess their social circumstances / home environment.
Requests for home visits
Visits should be requested before 11 am wherever possible so that they can be triaged appropriately and assessed for the degree of urgency. The visit request should be added to the duty doctor’s visit list for triaging. The duty doctor may telephone the patient or carer to obtain more information about the problem and to assess the degree of urgency and whether a visit is the most appropriate course of action.
If the doctor assesses the case and decides that the most appropriate and safest place to assess the patient is in the surgery, then the doctor can offer the patient an appointment in the surgery that day or at a time agreed by the patient and the doctor.
If the visit request is for a more urgent problem, the doctor may advise the patient or carer to call the emergency services or to attend Accident and Emergency directly as this may be more appropriate for the safe management of the patient.