VISITING a patient at home can be quite an adventure. As a GP I have waded through mud, tottered across slippery gang planks, been chased by geese, wandered around the wrong house and got lost on numerous occasions.
Once a patient collapsed with a heart attack as I walked into his bungalow and, on another occasion, I was faced by a young child rapidly going downhill with severe meningitis.
During home visits, I have given injections, delivered tablets, dressed wounds and sorted out many overstocked medicine cabinets. I have even nailed down a carpet and replaced a light bulb curing an elderly gentleman of his frequent falls.
Unfortunately, and especially in rural practices, home visits can take a lot of time and some leading GPs have recently voted for them to be scrapped. But the data shows that, in 2018, only one per cent of GP contacts with patients were during visits compared to around 10 per cent when I started in general practice in the late 1980s.
Working as a partner in a general practice today is certainly a lot more challenging than it was 20 or 30 years ago and GPs are seeing a lot more patients. But is ditching home visits really the right solution?
As GPs we have already given up looking after mothers throughout their pregnancies, stopped caring for our patients outside office hours and moved away from having our own list of individuals that we are responsible for. I no longer take blood, do any minor surgery, give immunisations, undertake family planning or even syringe ears. If I stop doing home visits, can I still call myself a general practitioner?
There is no doubt that some home visits are inappropriate or unnecessary. As an apprentice GP in Holmfirth, I remember waiting outside a patient’s house for them to return from the hairdresser. On another occasion I was summoned out of my bed at 1am to visit a 20-year-old with a sore throat who, when I arrived, was tucking into a large pizza with his friends.
But there are individuals who simply cannot easily travel to see me – the frail, the vulnerable, the dying and those with complex medical problems. These people probably need even more help from an experienced GP than many others who can get into the surgery.
Even under the current rules no patient can demand a home visit. It is up to the GP to decide if a home visit is appropriate and if it is urgent. It is also important to emphasise that the team of people working at my surgery can offer more and do more than I can on a home visit. As most clinical records are now computerised, I will have less information available to me during a home visit than I would in the surgery.
In some practices a senior GP might speak to patients requesting visits to assess the problem and to discuss whether a home visit is the best option. If an elderly lady has fallen and is unable to walk, then it is much more sensible for her to go straight down to the local hospital accident and emergency department to have her hip X-rayed. If a person has symptoms that might suggest a heart attack or a stroke – such as chest pain or sudden weakness of an arm or leg – then it is important that they get specialist treatment as quickly as possible using a 999 ambulance.
When it was put to Matt Hancock, the Health Secretary, that GPs wanted to give up home visits, he described the idea as “a complete non-starter”. But rather than just dismissing the call he should, perhaps, have asked why so many GPs feel under so much pressure that they want to give up a core part of their job.
My advice to Ministers is to explore how to allow GPs to get back to being GPs again. The administrative burden on all of us is now intolerable. It also feels as if every action I take as a GP is being scrutinised, controlled or questioned by a growing number of regulatory bodies and NHS managers. For example, I need to spend a day away from seeing patients having my annual appraisal in order to convince the local health authority that I am still trustworthy.
A few years ago I undertook a short sabbatical working as a GP on Alderney in the Channel Islands. There were no managers or regulators breathing down my neck and I had no targets to satisfy. I had time to spend with patients and practice real medicine again. As I said to a 91-year-old lady who offered me a cold beer after visiting her at home: “This is what general practice should be.”
Dr Nick Summerton is an GP in East Yorkshire – and an author.