At the end of November, doctors voted to scrap home visits by GPs. In a move that has received criticism from some quarters, around 300 delegates made the decision to try to remove the duty from their standard contract. It follows a proposal put forward by Kent Local Medical Committee to change the GP contract because GPs “no longer have the capacity to offer home visits”.
The proposal was supported by doctors at a meeting of English local medical committees in London. This means British Medical Association representatives will now lobby NHS England to stop home visits being a contractual obligation. Although the action has provoked accusations of negligence from some, for others it’s an unsurprising reflection of the desperate state of the NHS.
Medics at the conference of Local Medical Committees in London said it was time to make it clear that “enough is enough”, saying they were overloaded. The chairman of the BMA’s GP committee urged medics to encourage other doctors to refuse unmanageable workloads. The Union will now lobby the next Government for home visits to be outsourced, or to see GPs paid extra for carrying out such work.
The Health Secretary, Matt Hancock, has made his position clear, saying that the plan was a “complete non-starter” that he firmly opposed. He told BBC Radio 4’s Today program: “The GPs had a vote on what their opening negotiating position should be for the next GP contract. The idea that people shouldn’t be able, when they need it, to have a home visit from a GP is a complete non-starter and it won’t succeed in their negotiations,” he said.
A Telegraph article also lambasted the news, accusing doctors of abandoning the frail, elderly and vulnerable. The article goes on to say that in an age of consumer goods being delivered to your door, GP home visits are a critical part of building a ‘holistic’ relationship between patient and doctor: ‘A GP’s waiting room these days is no place to be ill: full of feverish children crying, adults coughing and sneezing.’
The article seems to suggest that GP home visits should be an automatic right that’s preferable to being seen in overcrowded surgeries. Yet this scenario overlooks the reality of a health service that’s clearly in crisis, without offering any solution. Claiming ‘NHS services seem increasingly geared to the convenience of staff rather than patients’ is a less than constructive criticism of staff who are already overworked to breaking point.
Home visits take up two to three hours a day for the majority of GPs in a schedule of back-to-back appointments. In addition to assessing patients, home visits require GPs to find patients’ homes and make judgements about their health conditions in none clinical settings – while still keeping to a strict time schedule.
Writing for the Independent, Berenice Langdon gives a first-hand account of the difficulties facing GPs: ‘How can I visit this patient, and make the other visits, and do my other work and get back in time for the afternoon clinic that starts in two hours’ time?’ she says. ‘Yesterday, my colleague did five visits at home. When I put my head around the door to say hello, his hands were shaking. “I can’t do it anymore. I don’t want to do it anymore,” he told me.’
Rather than simply dismissing home visits as an ‘indulgence they can’t afford’, as some papers have reported, GPs simply aren’t backed by adequate resources. The rising number of home visits not only takes up time that GPs don’t have, but requires GPs to go out in bad weather conditions to remote areas or high risk estates without any back-up or protection. This simply wouldn’t happen in other professions that carry out home visits, such as the police.
Statistics also show that home visits cause the most friction, complaints and litigation. Rather than understanding the additional pressures that GPs face in uncontrolled environments, many patients now see home visits as an automatic right. Langdon explains, “Home visits can’t be a ‘right;’ they are so resource-intensive that they must be saved for those who are bedbound, unable to move from bed to chair.”
The consensus then, is that home visits are an essential moment of human contact for many patients who can’t leave their homes. In an ideal situation, with less pressure, they would be an option for more people. Despite the government claiming that they’re going to fund and hire 6,000 more GPs, the resources currently available must be properly valued by reserving them for the most vulnerable. Both sides also agree that abandoning the pointless “integrated” care plans and tick-box targets introduced by the government would free up more time.
‘I agree with Kent Local Medical Committee that we should look carefully at the general GP contract,’ says Langdon. ‘The GP workload these days is so large, the experience so unpleasant, that many doctors can’t face it. Virtually every GP I know, male and female, works part time. The government spends all that money on training doctors, and then messes it all up by arranging a workday so horrible that no one can bear to do it.’
At the opposite end if the spectrum the introduction of “remote consulting” by Skype etc. could see the consequences of GP shortages if the current situation isn’t properly acknowledged. What’s clear from the proposal is that doctors won’t continue to tolerate their current working conditions. If GPs continue to leave the profession at the present rate, and with trainee GPs low in numbers, there won’t be any point in demanding home visits and other services as a ‘right’ if GPs simply aren’t there.
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