Home visits are breaking GPs like me – and now our most vulnerable patients are in danger

The scale of our responsibilities is so large these days that many doctors just can’t face it. Freeing up the service is not only possible, it’s essential and urgent

Berenice Langdon
Wednesday 04 December 2019 09:53 GMT
Retired GP says he has never been so worried for the NHS

I try to sound professional. “Of course, Mrs Smith, a home visit. I should be there in...”

My competent tone trembles a little as I try to calculate what time I can get there. Inside I feel a sense of panic as the number of visits builds up. 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?

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 dread my on-call day. I don't want to do it anymore,” he told me.

The Kent Local Medical Committee put forward a proposal 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 two weeks ago. This means British Medical Association representatives will lobby NHS England to stop home visits being a contractual obligation.

“Don't worry about the home visits,” I advised a GP trainee. “You think on the phone they are at death’s door and then they're always fine, with a sore toe or something.”

“Apart from this one home visit when the patient died in front of me,” I said.

The GP trainee is horrified – although you'd have to be observant to notice; a subtle momentary stillness, which he covered up well.

“That took a bit of getting over,” I concluded. “Still had to see my afternoon patients though.”

We see patients in rain, in hail. Once, it was snowing. I got completely soaked. I was like a hero. At least, that's how it felt, but no one even noticed. The partners didn't notice, the other staff are used to it, and the patients take it for granted.

Once – only once – a fellow doctor was concerned about my safety. I go unaccompanied into estates, past people smoking skunk in their cars. I enter people's homes with no kind of protection – except that I've told the receptionists that I am doing a home visit. If one day I don't return, I hope that they will notice, have the common sense to look up the address and call the police.

And before anyone mentions “remote consulting” or “Skype” – don't. What these tech-savvy idealists forget, in their drive to save money, is the human-to-human exchange. Part of the reason I feel drained after a day at work is that I have been using my energy to energise patients all day long.

Home visits are a key moment of human contact. I see the person’s bedroom, I see them move about the room, I see their stuff, I smell their house. I hang my coat on the door if there is nowhere else and wash my hands using the fairy liquid in their kitchen. I listen to their version of what is happening and I ring up their son or daughter.

I dread the build-up of home visits, the sense that I can't escape. But afterwards, I think about what I've seen and whether it was worthwhile. The point of home visits is not that they supply great anecdotes or allow me to view real estate. The point is that they allow people to live in their own homes even when they are bedbound.

If we value the ability to live in our own homes, rather than having to move to a nursing home, then we should value home visits. They are an important, special resource. We could let GPs know, by writing to them. GPs would really appreciate that.

I agree with Kent Local Medical Committee that we should look carefully at the general GP contract. 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 work day so horrible that no one can bear to do it.

In order to free up room for home visits, we could stop the pointless “integrated” care plans and tick-box targets. In addition, a new salaried-GP contract, endorsed by the government with a doable workload and proper maternity leave and sick leave, could go a long way in uncovering excellent GPs who are not yet partners. They might be motivated to increase the number of days they work with a plan that includes time allocated for home visits.

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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. Anyone who can walk in their house can also walk into a car and come to the surgery. Some partners even pay for cabs if patients refuse.

A good GP work plan to allow space in the doctor's day for home visits, a well thought out, salaried contract to attract young doctors back into doing sessions, a cab transport fund to encourage patients to get to the practice if they can even walk at all. And a flock of letters written to GPs to create goodwill and mutual respect.

If we value being able to live in our homes to the end, then we must value home visits and protect them, like we protect all endangered things.

Berenice Langdon is a GP in southwest London

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