Home visits can be an extra challenge in an already busy day and are frequently seen as unnecessary. A recent vote by the Local Medical Council (LMC) to negotiate removal of home visits from the NHS England GP core contract was ruled out by the Home Secretary, despite GPs being over-stretched to provide this service. In this article, Dr Hana Patel considers how to get the most out of a home visit: to benefit the patient, the visiting clinician and the practice team.
There are certain services GPs are obliged to provide as part of their contract with NHS England. One such service is home visiting for patients who consider themselves too ill to attend surgery or are at risk of spreading infectious illness to other patients by attending the surgery. Treating patients at home has always been part of the core work of a GP. With the practice team increasingly comprised of other health professionals, the number of home visits carried out by GPs in some areas is reducing.
The Care Quality Commission (CQC) and NHS England have issued patient safety alerts around the prioritisation of home visits for patients in general practice. This requires practices to ensure that there is a protocol in place to determine whether a home visit is clinically necessary and that there is a mechanism to assess the urgency of the home visit. It is important for all doctors to be familiar with their practice policy on home visits for patients.
How to prepare for a home visit?
After a busy morning or afternoon surgery and with the pressure of telephone calls, prescription requests and messages, it can be difficult to find enough time to visit a sick patient at home. However, the process of getting to the patient’s house could be viewed as part of ‘housekeeping’, to build resilience and break up the day, not a chore.
The administrative team can assist by printing out summaries, ensuring correct telephone numbers for the patient/next of kin and providing additional information needed for the home visit. It is advisable to plan your route before you leave and to confirm the time of the visit with patients before leaving. This can make the visit quicker as the patient will be expecting you. You may be able to prepare for the visit, perhaps by anticipating the prescription needed or speaking to the member of the practice team who saw the patient last.
Another home visit essential is the home visit bag. Table 1 gives examples of what can be included in your home visit bag to ensure that you have equipment for most eventualities.
Table 1. Equipment for home visit bag.
Table 1. Equipment for home visit bag.
Most practices use electronic prescribing, so handwritten prescriptions are not usually required. However, you may need to contact the local pharmacy to facilitate delivery of urgent prescribed medication to the patient before the end of the day.
To ensure your safety, it may be advisable to inform the practice team of the timing of your visit. If there are any safety concerns, you may want to ask a member of the administrative team to attend with you as a chaperone. For GP trainees working in rural areas, a torch to identify door numbers in the dark and warm weatherproof clothing may be required.
During the home visit
Often a lot of information can be gleaned about the patient and their surroundings from a home visit. It can provide a more holistic approach to their care and may offer an opportunity to consider other medical conditions and even an opportunity to update any information required for Quality and Outcomes Framework (QOF). Clinical examination can be more difficult, for example if space is limited, but it is imperative to be professional and courteous and to ensure patients’ dignity just as if in the surgery. There may be family and pets at home who may want to interact with you. They may need to be consulted about hospital admissions or advised about aspects of the patient’s care. Ensure that you have telephone numbers for the community service teams, local hospitals and colleagues. This can help ensure timely, appropriate care for patients.
After the home visit
Subsequent documentation of the visit is essential for medico–legal reasons, but also for continuity of care and safety of the patient. This may also be an appropriate time to restock equipment in your home visit bag. A debrief with your supervisor may be needed, as may sharing of information about the patient with relevant practice members. If the home visit was particularly challenging, or brought up concerns, it may be worth discussing these with GP trainee colleagues at your next teaching session.
Dr Hana Patel https://orcid.org/0000-0002-1056-9271
References and further information
General Medical Council (2013). The duties of a doctor registered with the General Medical Council. Available at: www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/duties-of-a-doctor (accessed 20 November 2019).
Neighbour R (1987) The Inner Consultation. Lancaster: Routledge.
NHS England (2016). Patient safety alert -- prioritisation of general practice home visits. Available at: www.england.nhs.uk/2016/03/psa-gp-home-visit/ (accessed 4 January 2020).
Conclusion: Any final tips? Home visits are still an essential core role for GPs. GP trainees might consider developing a template to ensure that patients being visited at home are given the same holistic care as those attending the surgery.Visit Details