Anviksha Patel looks at how different areas are already commissioning home-visiting services separate from the GP practice
‘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. 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.’
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.’
Who delivers it?
The CCG commissioned an acute home-visiting service in August 2018. BB Healthcare Solutions is now contracted to provide the service until March 2020.
How does it work?
GPs and advanced nurse practitioners employed through BB Healthcare Solutions visit patients who call their surgery before 10.30am.
All practices working with the service have a remote booking system, allowing them to book a patient directly into a slot. They are prioritised according to urgency, and patients are then told to expect a visit between their call and the evening.
What kind of visits does the service cover?
Housebound patients only. Some practices in the area advise that sick children and babies can ‘always’ be brought to the surgery.
Who delivers it?
The LMC updated its longstanding home-visiting guidelines last year to help GP practices decide what is an appropriate home visit. The local 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 advises that 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.
This article first appeared in Pulse magazine, January 2020 issue
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