View our home visiting pathway poster.

Our home visiting policy is based on Royal College of General Practice guidelines. You cannot insist that a GP visits you at home. GPs will only visit if your medical condition requires it and they will decide the timing of such visit.

In order to safely manage all our patients in the light of increasing demand, we are focusing home visits on patients who really need it.

It is nearly always better if GP’s are able to see patients at the surgery, a home visit recognises that some patients simply cannot attend the surgery. Visits are time consuming and the travel time could have been used to see other patients.

A home visit will not be agreed if the reason is due to your difficulties in getting to the surgery. The surgery is not responsible for ensuring that you have the financial means to attend the surgery nor that the patient chooses to register with a practice that is difficult for them to get to in bad weather or without a car.

GP’s are not obliged to visit a patient if they have assessed the patient’s clinical need on the telephone and found them to be suitable for an alternative method of healthcare. As long as the GP has provided a plan for a patient (which may be an appointment the same day, a future day, telephone advice or attendance at other healthcare site such as A&E, a message communicated via reception) then the GP has acted entirely correctly.

Background to the policy

Quality of medical care

• 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, absence of chaperones, unhygienic conditions and such simple difficulties as soft beds, making it impossible to examine the patient thoroughly.
• 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.
• Speed of treatment is facilitated by restricting home visits to those who really need it. Others are to be encouraged to attend properly equipped medical facilities where patients are seen quickly and those that need it, immediately.

International comparison

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

Issues for the profession

• Workload – The workload of British GP’s has increased greatly over recent years. It seems that it is set to rise further and unless GP’s are allowed to deliver care in the most efficient way possible the system seems likely to break down. If patients are seen at the surgery, rather than their own homes, then quite simply more patients can be attended to by a given number of clinicians.
• Safety – Doctors and nurses are particularly vulnerable to attack when home visiting.
• Stress/low morale/poor recruitment – Inappropriate requests for home visits are often quoted by GP’s and nurses as a major source of dissatisfaction.
• The current medico­‐legal climate is such that a GP, may 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.

Financial

• Cost – Paying highly trained and expensive GP’s to spend too much of their time driving themselves from house to house makes little sense.

Housebound register

• Patients who are evidently housebound or medically unfit to travel (eg palliative care) will be placed on a register which ensure that reception and the clinicians are aware a home visit may be appropriate.

Principle and fundamentals

• Terms of service– It is the doctor’s decision whether or not the patient can be reasonably expected to attend the surgery. The GP is only under obligation to visit the patient at any place other than the surgery if it is the doctor’s reasonable opinion that it would be inappropriate for the patient to attend the surgery. It is also very important to emphasise that there is nothing in the contract that prevents a doctor referring a patient directly to hospital without first seeing them, providing “the medical condition of the patient makes that course of action appropriate”.
• General practice is not an emergency service along the lines of the police or ambulance.
• Throughout the development of this policy, the quality of medical care offered by the GP’s and nurses to our patients has been of paramount importance. The emphasis is that clinical effectiveness must take precedence over patient convenience.

Examples of visiting guidelines

Situations where GP home visiting makes clinical sense and provides the best way to give a medical opinion:

• The terminally ill.
• The truly bed bound patient in whom travel to surgery by car would cause a deterioration in medical condition or unacceptable discomfort.

Situations where visiting is not usually required:

• Common symptoms of childhood, fevers, cold, cough, earache, headache, diarrhoea/vomiting and most cases of abdominal pain. These patients are almost always well enough to travel by car. The old wives’ tale that it is unwise to take a child out with a fever is blatantly untrue. It may well be that these children are not indeed fit to travel by bus, or walk, but car transport is sensible and always available from friends, relatives or taxi firms.

It is not a doctors’ job to arrange such transport:

• Adults with common problems of cough, sore throat, flu, back pain, abdominal pain are also readily transportable by car to the surgery.
• Common problems in the elderly, such as poor mobility, joint pain, general malaise would also be best treated by consultation at the surgery. The exception to this would be in the truly bed bound patient.