legislation regarding home GP visits, any rights?

[BazzaS]

 

We are told on one hand that there are not enough GPs for the ever increasing population, but also that GPs are working less hours (partly due to the higher number of women working part-time), or alternatively raking in the cash working as locums in A&E. If we can determine the truth perhaps we can tackle the problem.

 

If the GP's doing locums in A&E are doing so in their own free time, not skipping their NHS contractual duties & not exceeding their maximum hours .... Who are we to tell them how to spend their off duty hours?

 

It may be the NHS needs to make working in A&E more life/work balance friendly to attract more substantive (non-locums) or ensure the GP's are contracted to a minimum of NHS GP hours prior to being able to undertake locums : both of these wouldn't (IMO) be an unlawful restriction.

 

If I was in an ED, and got offered being seen by a GP (who may well have previously done the A&E job as a junior, and then has years of experience on top) or the junior who may be 1 or 2 years out of medical school : the GP for me, please.

[zippygbr]

Sorry to be slow, but what is a UCC setting?

 

I haven't had to call a doctor since 111 started. As I've said, the previous system worked in my town. There were numerous occasions where a doctor attended.

 

My view is that just as there should be a legal obligation on nurse to patient ratio in a hospital, there should be a similar requirement for doctors available for out of hours cover, providing home visits where necessary.

 

We are told on one hand that there are not enough GPs for the ever increasing population, but also that GPs are working less hours (partly due to the higher number of women working part-time), or alternatively raking in the cash working as locums in A&E. If we can determine the truth perhaps we can tackle the problem.

 

UCC= urgent care centre

 

Home vists are only required where it is dangerous or impractical for clinical reasons for the patient to attend a proper healthcare facility...

 

1. it wastes the time of the practitioner

 

2. the facilities available in even the most ill equipped surgery make undertaking an examination considerably easier than doing so at home

 

a number of OOH providers contract with or provide their own patient transport ambulances to facilitate patients attending a treatment facility.

 

GPs locuming in A+E are doing so on top of their contracted hours in the nHS, much as consultants working in private practice are doing so on top of their NHS hours ( and whether those commitments are in offices hours is irrelevant given the number of hours most consultants do outside of office hours as it is ...

[think about it]

Zippygbr has rasied some excellent points, there's an especially fine line between what constitutes an urgent GP visit and an emergency that requires a more acute response.

 

Home visits are especially time consuming and as said earlier are totally sub-optimal when it comes to the quality of the examination possible in the absence of anything but a few basic diagnostic tools in a briefcase.

 

There's also a bit of a more social issue here, solving transport difficulties isn't in the realm of the GP, it's good that some providers do use transport to bring people to clinics but with the exception of arranging non-urgent ambulances or in some cases, volunteer / community provided transport, I feel it's not always reasonable to expect a GP to come out because of this issue alone. That said, many will. GP's will however assist in referring people to social services but that really shouldn't wait until things are so bad that they become an emergency. In these cases a Social Services referral is done as an emergency and is simply directed to the on-call social worker, the limit of their reach may only be to set the wheels in motion.

 

I do believe there is a role for the reception team to provide guidance and assistance in accessing alternative means of transport where it's the sole limiting factor, however I quite often hear of how they're then being horrible or not listening.

 

That gap in service, the one that sees the muddy water between urgency and emergency is always going to be challenging. It's an ideal role for drop in centres / on the day appointments at GP surgeries. I understand, first hand, how frightening it can be to be unwell as do all of the team here hence the reason we do what we do and it's sad that on a frequent basis we hear from people who need help but then won't accept it in any other form than the one they want.

 

We see it more here in the rural setting of our practice. With respect, if someone is having difficulty breathing - can't move - isn't communicating as they usually do - is in utter agony and so on, DON'T call your GP, pick up the telephone and dial 999. However, if it's something you can manage with - is uncomfortable - is something that can wait - then see your GP.

 

There are of course exceptions to that, if perhaps someone is terminally ill and had decided they wanted to die at home then yes: call the GP, they'll already be aware of what's going on and do all they can to help.

 

One last thing about discharge planning, the planning for someone's discharge starts the moment they're admitted and for good reason. No hospital wants to think that a patient won't be discharged, it's reasonable therefore to start talking about leaving as soon as you arrive and gives those involved the chance to get things in place before the last day of someone's stay.

[Sali]

Thank you for englightening me on the meaning of UCC, Zippydr. I heard somebody use this acronym on the radio a few days later.

 

I am not against GPs working in A&E on occasions. New environments, I believe, make us all sharper and new experiences and situations can only enhance our knowledge.

 

However, we are left believing (rightly or wrongly) that it is not the pursuit of a life/work balance that the GPs seek, but as much cash as they can in the shortest possible time. But this golden carrot is only dangled before them because A&E cannot cope with demand. It's somewhat ironic then that patients who cannot get a timely appointment with their GP go the emergency department. As for NHS consultants who also work in private practice, well that is a whole other discussion.

 

We also hear that some practices are trimming their patient lists, citing increased demand, 'terminating' patients who may have been on their register forever. I do not know how common this is, but I would be a bit miffed if this happened to me and I found out that the GP was making a choice to work as a locum.

 

What are GPs contracted hours by the way?

 

Yes, Zippydr, I can see that attending a surgery is better for the doctor and probably for the patient, and I am sure that Thinkaboutit has encountered people who are not willing to compromise, but I think there is a category of people who do not fall into emergency or terminally ill who are somewhat neglected: The elderly.

 

I know of a lady, immobilised through rheumatism, isolated by deafness and with only one family member who lives in the area, who sometimes needs a home visit. Some GPs leave prescriptions with her when they must realise she has no possibility of obtaining the medicine. There also seems to be no automatic follow-up considering her vulnerability.

 

Oh, and as for patient discharge, Thinkaboutit, I'm not sure there's much planning involved at my hospital. It was clear to me that the team involved in the discharge of my relative had not taken the trouble of reading the patient notes or communicating with the patient or relatives. I would urge relatives or carers to ask questions before it happens to be sure that it is done right. Never make the mistake of thinking just because they do this all the time, they are good at it.

 

Anyway, going back to the OP. I am not clear whether she was told that doctors do not do home visits and therefore did not trouble to put this to the test, or whether doctors have made a decision that she is not worthy of a call-out.

[think about it]

Sali, GP's hours are generally measured in sessions. A session is one surgery, so a day may comprise of two sessions. As a surgery we have 19 sessions on a week split between two GP's one week they do 9, the next they do 10. That said, they're generally here from 08:20 until 18:30 each day with Wednesday being the exception which is a half day for us and we're covered by a neighbouring practice, we then return the favour on a Thursday. Our patients can almost always get an appointment on the same day, failing that, it's the following morning. There are no set hours as such, much like some people work part-time in any other role so do some GP's the only fixed factor is that surgeries must be open from 08:00 until 18:30, how a practice chooses to staff that time is up to them.

 

We cannot remove someone from our list without good reason and generally that's down to abusive / threatening behaviour, I take a remarkably dim view of such behaviour from patients as do my colleagues and wouldn't hesitate to remove someone who had shown consistently that they were rude or threatening to any member of our team. There may, in other practices, be occasions where they are left with no option but to reduce their list size. This might be spurred by the retirement of a partner and the subsequent inability to recruit a replacement. It makes good sense to maintain a certain ratio of patients per GP however; from recent talks it seems that there is no hard and fast rule.However, if the practice feels that safety is impacted then it has to act, this again has to be in conjunction with the local health board. If it were truly a monetary consideration then it would make sense to have as many patients as possible with as few doctors as possible. List size and disease prevalence is what drives the funding that's linked to performance targets set against each chronic condition.

 

Let's make things perfectly clear, any locum work is done in the GP's own time. Now, that might be of an evening, weekend or perhaps whilst taking annual leave and just as I wouldn't accept anyone (other than my wife, of course) telling me what I can / can't do in my own time, neither should anyone else. Individual motives for doing so are exactly that, the overwhelming Daily Mail /gutter press assumption that doctors want to earn money is hardly shocking, I don't go to work for the fun of it, I do it because I have bills and responsibilities to meet.

 

There's a frankly unusual fascination with earnings in these papers, but look at any job (and that's what being a doctor is) with similar levels of qualification and responsibility and the picture is no different. I have no problem with the fact that an Airline Captain earns £100,000 to fly people toand from Florida - it takes years of training and dedication to get there and that is reflected in the pay, likewise for specialist engineers, lawyers so on and so forth. I know from firsthand experience that the path to becoming a GP is long, challenging and fiercely expensive - my wife qualified in 2000 and just recently after years in hospital medicine, self funded study and exams and the strain it puts on home-life became a GP. I can also say that the figure of £100,000 per year is not the case for the majority. Perhaps less than half of that in some cases. For some doctors it’s a case of then prioritising their own life and family and working hours that enable them to do just that. Again, that’s a decision only they can and indeed should make.

 

It’s hardly headline news really, “Someone decides to work a bit less so they can spend time with their family” or “Someone decides to work some overtime” but the press are marvellous at creating a furore over nothing.

 

I read your piece about the lady above, and I agree with what you're saying. However, the GP's role is to treat the patient and the conditions she has, it's a matter for social services / family to provide the day to day support that she requires. Pharmacies can and will deliver to vulnerable people, a mentionof the difficulties in obtaining the medication would / should spark a phonecall to her nearest pharmacy to arrange for the ‘script to be sent over to them and for the person to have the medication delivered. If the lady’s medical condition requires follow up then that will be communicated to the GP by theout of hours / visiting doctor but again, it’s important to realise the limitations of what can be done in someone’s home as opposed to a clinicalsetting. I said in an earlier post that there is, and needs to be, a distinction between the role of a GP as a medical doctor and a social worker. Doctors, on the whole, are good at what they’ve trained to do, the same can be said for the majority of Social Workers and in a case of need they will work together but there is as much onus on the rest of us to identify and help people in need to the best of our abilities and not assume that someone else will do it. Services exist to help people in situations like the one you describe but a GP is not the only gateway into them.

[Nystagmite]

Isn't a home visit a reasonable adjustment under the Equalities ACt 2010?

[think about it]

Isn't a home visit a reasonable adjustment under the Equalities ACt 2010?

 

That's an interesting one, I suppose it's a case of under what grounds it's being requested. We see, on a daily basis, people with all manner of disabilities come through our doors, but what is clear is that they have resolved any transport issues they've had to the point where they're able to travel.

 

Far better perhaps is that the 'home visit' is based on clinical needs, no surgery has the resources to visit everyone for whom travelling is difficult. If however, someone can't travel due to a medical condition, then they ought to be visited. The limitations are of course that the options available to the clinician are severely limited and it may be the case that further examination is required in a more appropriate setting.

 

I've said in earlier posts and will re-iterate that even with all of the training, experience and portable equipment there is only so much a GP can do whilst in someone's home. It's unfair to speculate on the OP's condition and what the GP might have been able to offer beyond pain control. Such is the grey area in urgency/emergency that a case-by-case review is the only sensible way to operate.

[estellyn]

I think there are few occasions when someone can't get to the surgery - I requested a home visit last year (the first time ever), the GP called back asked about my symptoms and requested I come to the surgery instead. My husband bundled me into a taxi and I went - I was seriously ill and was immediately hospitalised (I think the GP felt bad about denying the home visit - he called my husband the next day to check on me). But the reality was I did make it to the surgery, and that GP was able to see others at the surgery in the time it would have taken to do a home visit, including a very poorly child who went in before me.

 

Though when we're really, really ill it is uncomfortable to get to the surgery, it is for the best if we can manage it, unless truly unable to leave the house.

 

Hopefully once new technology becomes more acceptable and widespread, more consultations could be done via skype. Even now, many of my GP visits could easily be done with a simple phone call which saves time and resources.