Home Visit Policy

Home Visit Service – Patient Leaflet

URGENT SYMPTOMS: Chest pain, shortness of breath and loss of consciousness are emergencies so please dial 999 for an ambulance.

Requesting a Home Visit

Requests for visits must be made before 10am and usually at the latest by midday. Visiting will normally take place after morning surgery.

Home visits are for patients who are housebound or medically incapable of coming to the surgery. It is better for patients if they are examined at the surgery, where clinicians have access to equipment, good lighting, examination facilities and most importantly your notes with your full medical history and medications..

You will be asked the reason for the visit. Our receptionists are trained to deal with your call and to do so sensitively and confidentiality. Some patients will be placed on a Housebound Register so that reception are immediately aware a visit may be appropriate.

We rarely visit children at home as a responsible adult should be available to bring them to the surgery.

You will normally receive a telephone assessment prior to a visit, which may conclude that no visit is required.

Please remember that transport issues are NOT a reason for a home visit. This service is only for patients who are housebound or medically incapable of attending the surgery

Home visiting policy

Our home visiting policy is based on Royal College of General Practice guidelines.You cannot insist that a GP visits you at home. GPs will only visit if your medical condition requires it and they will decide the timing of such visit.

In order to safely manage all our patients in the light of increasing demand, we are focusing home visits on patients who really need it.

It is nearly always better if GPs are able to see patients at the surgery – a home visit recognises that some patients simply cannot attend the surgery. Visits are time consuming and the travel time could have been used to see other patients.

A home visit will NOT be agreed if the reason is due to your difficulties in getting to the surgery. The surgery is not responsible for ensuring that you have the financial means to attend the surgery. nor that the patient chooses to register with a practice that is difficult for them to get to in bad weather or without a car.

GPs are not obliged to visit a patient if they have assessed the patient's clinical need on the telephone and found them to be suitable for an alternative method of healthcare.As long as the GP has provided a plan for a patient (which may be an appointment the same day, a future day, telephone advice or attendance at other healthcare site such as A&E, a message communicated via reception) then the GP has acted entirely correctly.

Background to the Policy

1. QualityofMedicalCare

a.Adoctor’sabilitytoproperlyassessandtotreatapatientseenintheirownhomeisoftenimpairedbythenon-idealclinicalsituationofpoorlighting,absenceofchaperones,unhygienicconditionsandsuchsimpledifficultiesassoftbeds,makingitimpossibletoexaminethepatientthoroughly.

b. Astechnologymoveson,sophisticatedtests,treatmentsandequipmentarebeingincreasinglyemployedtoimprovecare;muchofthisisnotportableandthusnotavailableonhomevisits.

c.Speedoftreatmentisfacilitatedbyrestrictinghomevisitstothosewhoreallyneedit.Othersaretobeencouragedtoattendproperlyequippedmedicalfacilitieswherepatientsareseenquicklyandthosethatneedit,immediately.

2. Internationalcomparison

NoothercountryhasadoptedthevisitinghabitsofBritishgeneralpractice.

3. Issuesfortheprofession

a.Workload.TheworkloadofBritishGPshasincreasedgreatlyoverrecentyears.ItseemsthatitissettorisefurtherandunlessGPsareallowedtodelivercareinthemostefficientwaypossiblethesystemseemlikelytobreakdown.Ifpatientsareseenatthesurgery,ratherthantheirownhomes,thenquitesimplymorepatientscanbeattendedtobyagivennumberofclinicians.

b. Safety.Doctorsandnursesareparticularlyvulnerabletoattackwhenhomevisiting.

c.Stress/LowMorale/PoorRecruitment.InappropriaterequestsforhomevisitsareoftenquotedbyGPsandNursesasamajorsourceofdissatisfaction.

d. Thecurrentmedico‐legalclimateissuchthataGP,mayhavereservationsabouttheprudenceofmakingdecisionsbasedonanassessmentmadeinthefarfromidealclinicalsettingofapatient’shome.

4. Financial

Cost.PayinghighlytrainedandexpensiveGPstospendtoo muchoftheirtimedrivingthemselvesfromhousetohousemakeslittlesense.

5. Housebound Register

Patients who are evidently housebound or medically unfit to travel (eg palliative care) will be placed on a register which ensure that reception and the clinicians are aware a home visit may be appropriate.

PrincipleandFundamentals

1. TermsofService.Itisthedoctor’sdecisionwhetherornotthepatientcanbereasonablyexpectedtoattendthesurgery.TheGPisonlyunderobligationtovisitthepatientatanyplaceotherthanthesurgeryifitisthedoctor’sreasonableopinionthatitwouldbeinappropriateforthepatienttoattendthesurgery.

ItisalsoveryimportanttoemphasisethatthereisnothingintheContractthatpreventsadoctorreferringapatientdirectlytohospitalwithoutfirstseeingthem,providing“themedicalconditionofthepatientmakesthatcourseofactionappropriate”.

2. Generalpracticeis NOT anemergencyservicealongthelinesofthepoliceorambulance.

3. Throughoutthedevelopmentofthispolicy,thequalityofmedicalcareofferedbytheGPsandNursestoourpatientshasbeenofparamountimportance.Theemphasisisthatclinicaleffectivenessmusttakeprecedenceoverpatientconvenience.

ExamplesofVisitingGuidelines

1. SituationswhereGPhomevisitingmakesclinicalsenseandprovidesthebestwaytogiveamedicalopinion:

a.Theterminallyill.

b. Thetrulybedboundpatientinwhomtraveltosurgerybycarwouldcauseadeteriorationinmedicalconditionorunacceptablediscomfort.

2. Situationswherevisitingisnotusuallyrequired:

a.Commonsymptomsofchildhood,fevers,cold,cough,earache,headache,diarrhoea/vomitingandmostcasesofabdominalpain.Thesepatientsarealmostalwayswellenoughtotravelbycar.Theoldwives’talethatitisunwisetotakeachildoutwithafeverisblatantlyuntrue.Itmaywellbethatthesechildrenarenotindeedfittotravelbybus,orwalk,butcartransportissensibleandalwaysavailablefromfriends,relativesortaxifirms.

Itisnotadoctors’jobtoarrangesuchtransport

b. Adultswithcommonproblemsofcough,sorethroat,“flu”,backpain,abdominalpainarealsoreadilytransportablebycartothesurgery.

c.Commonproblemsintheelderly,suchaspoormobility,jointpain,generalmalaisewouldalsobebesttreatedbyconsultationatthesurgery.Theexceptiontothiswouldbeinthetrulybedboundpatient.

SSGMP Home Visiting Policy June 2016. Revision: 2018

Home Visiting Pathway

Requestformedicalcaremadebypatient(usually bytelephone)toGPorotherclinicianandbackedbyappropriateprotocols

Canthemedicalproblembemanagedbytelephoneadvice?

SSGMP Home Visiting Policy June 2016. Revision: 2018

YES

GPprovidestelephoneadvice+/‐prescription

SSGMP Home Visiting Policy June 2016. Revision: 2018

YES

Arrangeforthepatienttoattendthesurgeryinatimescalebefittingthemedicalcondition

YES

SSGMP Home Visiting Policy June 2016. Revision: 2018