Llynfi Surgery Home Visit Policy

Chest pain, shortness of breath and loss of consciousness are emergencies please dial 999 for these symptoms

Although a traditional part of general practice, home visits are time consuming. Please remember that several patients can be seen in the practice in the time that it takes to make one home visit. So please help us to help you and our other patients by visiting the surgery whenever possible.

Home Visits are reserved for the following groups of patients:

• Terminally ill;
• Housebound;
• Patients who are severely ill in bed;

 Please request visits before 11am whenever possible as this allows the Duty Doctor to assess the request for necessity and urgency so that it can be appropriately managed. In some situations the Duty Doctor may arrange assessment by another member of the community team (District nurse/neighbourhood team)

The following ARE NOT valid reasons to perform a home visit:

Transport issues for the patient

• It is not the GP practice responsibility to arrange transport, or to perform home visits because the patient has difficulty arranging transport. In these circumstances patients should seek transport help from relatives, friends, or taxi firms.

Childcare issues for a patient

• If a patient has difficulty arranging for someone to care for their children whilst attending appointments, the patients are welcome to bring their children to the surgery.

Poor mobility

• Whilst it is understood that having poor mobility is inconvenient and unpleasant, GP surgeries are designed to cater for patients with restricted mobility. If patients are able to attend appointments at other healthcare settings, then they should also be expected to attend appointments in GP surgeries.

An unwell child

• It is in the best interest of the child to attend the surgery where they can be properly assessed and treated. The clinician can make a more informed clinical judgment when seeing the child in surgery. If a parent believes that the child is too unwell to travel to surgery, and is a medical emergency then it would be advisable for them to seek help from the emergency services by calling 999.

 REASONS BEHIND THE NEED TO RATIONALISE GP HOME VISITING

1. QUALITY OF MEDICAL CARE
2. A doctor’s ability to properly assess and to treat a patient seen in their own home is often impaired by the non ideal clinical situation of poor lighting, unhygienic conditions and such simple difficulties as soft beds, making it impossible to palpate abdomens correctly.
3. As technology moves on, sophisticated tests, treatments and equipment are being increasingly employed to improve care, much of this is not portable and thus not available on home visits.
4. Speed of treatment is facilitated by restricting home visiting to those patients who really need it. Others are to be encouraged to attend properly equipped medical facilities where triage can take place, ensuring patients are seen quickly and those that need it immediately.
5. A change of patterns of care during evenings and nights from the traditional model where many GPs each see a few patients through the night at patients’ homes, to a situation where fewer doctors see many patients in properly equipped and staffed centres is more efficient.
6. Local services/initiatives for referral of patients to avoid hospital admissions are now in use. These may not always require a GP home visit and can be accessed by others such as Community Matrons. Patients have greater availability to consult a GP or nurse at Walk-In Centres outside GPs’ normal working hours when carers or family can take them to such centres thereby avoiding the need for a GP home visit.
7. OUT OF HOURS ARRANGEMENTS AND 111

GP Out of Hours services only function properly if the majority of patients attend the centres, rather than being visited at home. Triage by professionals who are not GPs occurs in many centres and they will base decisions on guidelines similar to these. It is not the role of 111 to decide whether a GP visit is required but to recommend the patient contacts their GP.

3. INTERNATIONAL COMPARISON

No other Country has adopted the visiting habits of British general practice.

4. ISSUES FOR THE PROFESSION
5. Workload. The workload of British general practitioners has increased greatly 3 over recent years. It seems that it is set to rise further and unless GPs are allowed to deliver care in the most efficient way possible the system seems likely to break down. If patients are seen at designated centres, rather than their own homes, then quite simply more patients can be attended to by a given number of clinicians.
6. Safety. Doctors are particularly vulnerable to physical attack when home visiting, walking alone through inner city streets with a black bag is far from safe for GPs of either sex.
7. Stress/Low Morale/Poor Recruitment. Inappropriate demands for home visits are often quoted by GPs as a major source of dissatisfaction.
8. d. The current medico-legal climate is such that it is reasonable for a GP, with some justification, to have reservations about the prudence of making decisions based on an assessment made in the far from ideal clinical setting of a patient’s home.
9. FINANCIAL Cost. Paying highly trained and expensive GPs to spend much of their time driving themselves from house to house makes little sense.