Reasons behind the need to rationalise home visiting

Quality of Medical Care

• A doctor’s ability to properly assess and treat a patient 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 equipment 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 the properly equipped medical facilities where patients can be 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 GPs has increased greatly over recent years.  It seems that it is set to rise further and unless GPs are allowed to deliver care in the most efficient way possible the system sseemslikely 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 Moral/ Poor Recruitment.  Inappropriate requests for home visits are often quoted by GPs 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 settings of a patient’s home.

Existing guidance

• This policy has been developed in conjunction with existing guidance from the Local Medical Committees.