GPs want to remove ‘old-fashioned’ home visits from their NHS contract

Content originally from The Times

GPs’ leaders are calling for an end to home visits because they no longer have the time in their working day for the “anachronistic” practice.

Doctors will debate a motion this month that calls for GPs’ obligation to carry out home visits to be dropped from their contract.

The motion, to be put forward at a conference of the local medical committees in England by the committee representing GPs in Kent, calls for the removal of “the anachronism of home visits from core contract work”.

Instead, the body wants a separate contract to be drawn up that would allow paramedics and other healthcare professionals to carry out home visits.

If it is approved at the meeting on November 22, it would go to the GPs committee of the British Medical Association (BMA), which would negotiate the change with NHS England.

In 1995 home visits accounted for 9 per cent of all GP appointments. This had fallen to 4 per cent by 2008 and the latest estimates, for September, show that they now account for only 0.9 per cent of appointments.

In 1995 some 3 per cent of appointments were conducted by telephone, a figure than now stands at almost 13 per cent. Some 0.7 per cent of appointments are now conducted online or by video call.

Andy Parkin, a locum GP who put forward the motion, told the healthcare news website Pulse Today: “The main thing is the workload and demand on time in general practice. It’s not to remove the ability to do home visits if GPs want to. If there are truly housebound patients or palliative care patients, I think GPs should still be able to do that.

“The key thing is to remove the expectation that home visits are a part of general practice. They are the most time-consuming part of the job.”

He said that GPs also now covered wider areas and added: “In Kent, there is a home-visiting service run by paramedics and nurses. Urgent visit requests are passed over to them but they have a limited capacity.”

GPs are frustrated by their increasing workloads but debate remains over whether eliminating home visits would substantially reduce this, since they account for such a small proportion of appointments now. A home visit takes substantially more time than an appointment in a surgery, however.

One insider told The Times: “It’s a difficult one to call. In Wales last week they rejected a similar motion calling for no home visits after 2pm.”

Welsh GP leaders had called for urgent home visits after 2pm to be carried out by urgent care or ambulance services.

The local medical committees in England considered a motion to scrap the obligation to carry out home visits three years ago but it was rejected. The obligation remains in the new five-year GP contract that was agreed between NHS England and the BMA and which came into force in April.

The Royal College of GPs expressed sympathy with the motion but appeared not to back it fully.

Helen Stokes-Lampard, its chairwoman, said: “Home visits can be very time-consuming and take the GP away from the surgery when they could be seeing other patients, and where there are far better facilities to properly assess patients.

“But for some of our more complex and vulnerable patients, home visits are an invaluable, and often the only, means of seeing their GP.

“We are very supportive of proposals to train other members of the GP team, such as physician associates and advanced paramedics, to carry out home visits as appropriate, but they are not a substitute for GPs and it is vital that patients who need the skills of a GP are able to access them.”

The BMA declined to comment until after the vote.