Visiting patients at home is a part of the GMS contract.
The GMS contract states;
7.6.1 In the case of a patient whose medical condition is such that in the reasonable opinion of the Contractor attendance on the patient is required and it would be inappropriate for the patient to attend at a place where services are provided in normal hours under the Contract, the Contractor shall provide services to that patient at whichever in its judgement is the most appropriate of the following places:
(a) the place recorded in the patient’s medical records as being his last home address;
(b) such other place as the Contractor has informed the patient and the Board is the place where it has agreed to visit and treat the patient;
(c) some other place in the Contractor’s practice area.
7.6.2 Nothing in this clause or clause 7.6.1 prevents the Contractor from:
(a) arranging for the referral of a patient without first seeing the patient, in a case where the medical condition of that patient makes that course of action appropriate; or
(b) visiting the patient in circumstances where this clause or clause 7.6.1 does not place it under an obligation to do so.
In other words, GPs should visit patients at their homes, or other places within their practice area, if the patient’s medical condition makes attendance at the GP surgery inappropriate.
The LMC thus recommends that GPs should visit patients in their homes if they feel that they are medically unfit to travel to the surgery. It is important that practices triage requests for home visits for necessity and urgency, so that they can be appropriately managed.
However, there are a number of reasons why home visiting may be detrimental to patients;
- It can delay clinical assessment, as visiting cannot be carried out on an emergency basis, whereas assessing patient in the surgery can be
- Travelling to and from home visits can delay clinical assessment as the doctor may not be able to locate the patient’s address as quickly as the patient can attend the surgery
- Travelling to and from home visits, when clinically not needed, could prejudice the care of patients in the surgery, as the absent doctor will not be able to treat routine or emergency patients whilst away from the surgery
- Equipment for assessment and treatment by a GP which is portable to a patient’s home is not as effective as the equipment in the surgery
- The environment in a patient’s home is not ideal for clinical examination and assessment
Thus, the LMC also advises practices that reasons other than being medically unfit do not constitute a reason to perform a home visit. These reasons may include;
- Transport issues for the patient
- It is not the GP practices responsibility to arrange transport, or to perform home visits because the patient has difficulty arranging transport. In these circumstances patients should seek transport help from relatives, friends, or taxi firms
- Childcare issues for a patient - If a patient has difficulty arranging for someone to care for their children whilst attending appointments, the patients are welcome to bring their children to the surgery
- Poor mobility - whilst it is understood that having poor mobility is inconvenient and unpleasant, GP surgeries are designed to cater for patients with restricted mobility. If patients are able to attend appointments at other healthcare settings, then they should also be expected to attend appointments in GP surgeries
The unwell child
Children with a fever will not be made worse by transporting a child to a place of care. It is in the best interest of the child to attend the surgery where they can be properly assessed and treated.
If a parent believes that the child is too unwell to travel to a surgery, then it would be advisable for them to seek help from the emergency services by calling 999. If the GP feels that attending the child at home, based on the clinical history, may prevent delay in treatment because of distance from available ambulance services, then they should attempt to do so.
Residents of care home
Care home residents are no different to patients in their own homes. The need to visit should be based upon clinical need, not the availability of transport or staff to attend the surgery. It is the responsibility of care facilities to make transport available for residents so that they can get to medical and non-medical appointments.
The LMC encourages GP practices to use this guidance to generate a home visiting policy for the practice, which should be shared with patients and PPGs.