Visiting Policy

General Practitioner Visiting Guidelines Endorsed by East Kent Health Authority

Introduction

There have been significant changes in British general practice over recent years, and similarly great changes in the structure of British society, particularly in terms of housing, wealth, attitude, welfare provision and mobility.

With this change in mind, it is rather surprising that the visiting practices of general practitioners in many cases remain much as they were at the inception of the National Health Service and before.

There is no doubt that this failure to adapt is due in part simply to habit. From the patient point of view visiting is convenient, they may be blissfully unaware that domiciliary care in many cases impedes the provision of modern medicine. As far as the doctor is concerned he/she may well remain unsure as to where he/she stands in relation to his contractual obligation and might fear that to modify established patterns of visiting behaviour may render him/her at risk of criticism.

In the Summer of 1995, another Local Medical Committee decided that patients, doctors and all those involved in health care provision would benefit from a review and rationalisation of the role of home visiting in modern general practice. To do this, a group of general practitioners from across the County met and developed these guidelines. In undertaking this they took into full account the need to provide to patients medical care of the highest standard, the need to provide services in a fashion that complies with their contractual obligations, and also recognising that there is a need to be efficient in provision of care in order to cope with an ever increasing workload as technology moves on and care shifts from the secondary to primary sector.

The resulting guidelines in their current form have been produced by the East Kent Local Medical Committee for the assistance of general practitioners but must be regarded as general advice subject to the decision/judgement of individual general practitioners as to their applicability with regard to each set of circumstances.

Reasons behind the need to rationalise GP home visiting

Quality of Medical Care

A doctor's ability to properly assess and to treat a patient seen in their own home is often impaired by the non ideal clinical situation of poor lighting, unhygienic conditions and such simple difficulties as soft beds, making it impossible to palpate abdomens correctly.

As technology moves on, sophisticated tests, treatments and equipment are being increasingly employed to improve care, much of this is not portable and thus not available on home visits.

Speed of treatment is facilitated by restricting home visiting to those patients who really need it. Others are to be encouraged to attend properly equipped medical facilities where triage can take place, ensuring patients are seen quickly and those that need it immediately.

A change of patterns of care during evenings and night from the traditional model where many GPs each see a few patients through the night at patients' homes, to a situation where fewer doctors see many patients in properly equipped and staffed centres, will result in many fewer patients being treated the following morning by tired, and some may say, less "safe" doctors.

Relationship to the new Out of Hours arrangements

It is likely that the changes to GPs out of hours service will, in many cases, involve the provision of out of hours primary health care centres. Such a strategy will clearly only function properly if the majority of patients attend the centres, rather than being visited at home.

International Comparison

No other country has adopted the visiting habits of British general practice.

Doctor Attwood adheres to the above policy. He does however visit for some medical reasons and for the truly bedbound. If a home visit request is made it is usual for a telephone call to be made to ascertain the reasons for the call.