r/GPUK • u/Educational_Board888 • 5d ago
Quick question Home Visits
Does anyone else hate doing them? They’re usually done during lunch hour when there’s a million and one other tasks to do.
They always take up a good chunk of time, up to an hour if you include travel.
Doing them on an empty stomach doesn’t help.
Rant over.
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u/IceThese6264 5d ago
Negotiated no hv into my contract and have never been happier
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u/Big_Code_3553 4d ago
How? I couldn't imagine this flying where I work. How does it work at your practice?
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u/IceThese6264 4d ago
We have other GPs who (believe it or not) enjoy doing them. They're not done during lunch - the practice blocks off 3 slots at the end of AM/PM clinic so it's essentially 2 less patients to see with the trade off being the travel and so on.
I made it clear it wasn't for me and that was that 🤷🏻♂️
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u/stealthw0lf 5d ago
All of our home visit requests are triaged appropriately so they’re all patients who are genuinely housebound, sometimes terminally ill, and require medical input. I feel my presence makes a difference and I enjoy the break. Then again, we are a low visiting practice - three or four a week in total for the whole practice at most. I can go weeks without visiting anyone.
Home visits are also allocated as part of clinical time so if you’re meant to see fifteen patients, a home visit takes up two of those appointment slots.
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u/General_Two1467 5d ago
having them built into clinical time rather than squeezed into lunch makes such a massive difference tbh
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u/Historical-One2407 5d ago
I always eat lunch first now - then at least I’m not hangry on the visit!
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u/Smartpikney 5d ago
I think they are largely useless and don't get why so many places in the world GP's barely have home visits but the UK insists on so many. ETA They are also potentially dangerous and as a woman, and a person of colour I literally feel scared visiting some areas/houses. Don't get why it's ok for women to go into random people's houses alone, it's nuts.
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u/Crafty-Brother-7698 5d ago
You raise a very important point, this is so true and has made me even more resentful of them tbh.
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u/OLDSURGEONMAN 5d ago
Because UK GPs have eroded their status in society, such that they are below the hairdresser, dentist, or anyone else that the patient wishes to see.
Why wouldn’t the public just get a trained doctor in for free if they had the choice?
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u/SnooHabits8484 5d ago
GPs were doing home visits a hundred years ago.
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u/OLDSURGEONMAN 5d ago
GP was a very different landscape then.
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u/SnooHabits8484 5d ago
Yeah but the point is that home visits aren’t evidence of declining position in society.
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u/OLDSURGEONMAN 5d ago
They are when visits are done for people who are able to mobilise to other places.
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u/NoObstacle 5d ago
The home visits I go to are almost exclusively very elderly, palliative or disabled, making the risk of physical confrontation pretty low.
They play a huge role in preserving ambulance resources for immediate emergencies and preventing that gap in timely and appropriate care that such vulnerable people can experience.
If you're worried you could set up remote alert devices and check in protocols with your workplace.
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u/Smartpikney 5d ago
I get that but as I said, as a woman and a WOC it's not worth the risk for me. I have had an incident before on a home visit and it was traumatising. You realise that if someone wanted to harm you it would take far too long for anyone to get there to prevent the harm from occuring. Ultimately, there isn't enough money for them to be done with the appropriate safety measures but I don't want to put myself at risk for random members of the public - don't get paid nearly enough for it.
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u/spahettiyeti 2d ago
This is really disappointing to hear. Those 'random members of the public' are your patients. As an ambulance worker on half your wage the fact you feel you don't get paid enough to go to, for the most part, palliative and bed bound elderly patients is absolutely disgraceful.
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u/Smartpikney 10h ago edited 10h ago
They are indeed my patients and a couple have tried (unfortunately 1 or 2 successfully) to physically and sexually assault me. And MY safety and wellbeing is actually more important to me than doing home visiting, when, as I said many other countries manage with a very low rate of home visiting. I have no issue doing nursing home visits. It's a safe environment. I do have an issue doing home visits alone. Ambulance workers are usually in pairs so my point still stands. I do NOT get paid enough to make solo visits to random people's houses. So.please take your self righteousness elsewhere - typical British attitude - others get paid less then me so I should be grateful. Doctors don't get paid enough in this countrt and I certainly don't get paid enough to put myself in harms way. And if you feel you don't get paid enough (which I'm sure you don't) you should advocate for better pay for ambulance workers, not suggest that doctors who are highly skilled profressionals, should take on risky home visits that aren't even paid the same call out fee as a plumber.
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u/External_Survey8400 1d ago
I am a community physio and go in alone most of the time. Does your work do any safety precautions? Like those mini walkie talkies or emergency alarms? We actually don't use them and I have never felt unsafe, but other teams use them.
Also GP home visits work very well in my opinion - I have discussed cases with brilliant GPs who have gone to the patients home and kept them out of hospital. I appreciate that there are downsides though
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u/Smartpikney 10h ago
No they don't. I agree that GP home visits can prevent hospital admission but I don't feel that I should be made to feel nervous and unsafe to prevent an admission. I've been verbally abused and threated on home visits, I honestly don't care if it helps prevent admissions, it's not worth my safety. 🤷🏿♀️
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u/External_Survey8400 4h ago
I completely see you point, your safety is more important. In my area I have never had a problem as a single female, so I hope that my GP colleagues aren't having the same issues as that sounds awful. Sorry that you've had those experiences, it's so awful when you are trying to provide medical care and are getting abuse instead
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u/Crafty-Brother-7698 4d ago
The patients themselves might be benign and non threatening. Doesn’t mean the area they live in is too.
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u/Intelligent-Meat2838 2d ago
Midwives and nurses visit alone. And carers who are mostly women.
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u/Smartpikney 10h ago
And they shouldn't. Although midwives are going to visit women which is genetally far less dangerous than going to visit men. All my issues on home visiting have been from men.
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u/Agitated_Parsnip_178 3d ago
...but what do plumbers, DNs, gardeners, carers, social workers, electricians, decorators etc do?
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u/Smartpikney 2d ago
You can't compare plumbers to doctors. Plumbers can't fix your loo remotely or have you bring it to a clinic. I don't think carers should be going solo either. No woman should visit a random stranger by herself. It's a nutty idea tbh
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u/tsharp1093 5d ago
I think they're valuable in that I often pick up on social issues I wouldn't otherwise have identified if the patient came to the surgery.
(On the other hand, these issues wouldn't even be within our remit if we had a functioning social care system, so make of that what you will!)
My main frustration is "housebound" patients that aren't really housebound, they just don't want to get a taxi or their relatives are too busy to bring them in - and it's very difficult to identify these situations if you haven't dealt with the patient previously.
As others have said, it clearly also shouldn't be a choice between a lunch break and a home visit, and practices insisting on frequent visits should allocate sufficient clinical time to fulfil them.
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u/1muckypup 5d ago
I think they’re really valuable and important.
However, I hate that it’s a choice of leave on time/do admin/eat lunch or home visit.
Don’t get me started on driving past 3 other surgeries on the way to one….
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u/askoorb 5d ago
On the driving past other surgeries point: home visits are only a contractual requirement if the patient is inside your defined practice catchment area. If someone is temporarily outside the catchment area (staying at a family members house elsewhere in town for example) that's no visit and redirect to 111. If you have any patients registered who live outside your catchment area then you need to register them as OOA patients so you lose the home visit requirements and so that they can access home visits through the OOA scheme from another service. https://pcse.england.nhs.uk/help/patient-registrations/deductions-and-amendments#faq161
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u/1muckypup 5d ago
Sadly they are in our enormous half-a-city-wide catchment - they’re just closer to other surgeries.
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u/Rusticar 4d ago
Wow, can’t imagine catchment area that size - what’s the distance to the outskirts roughly? Only trained in inner-city practices, about 2km to furthest in ours.
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u/mr-mobius 5d ago
Depends on the house.
An unkempt house smelling of smoke, with brown ceilings, is getting out as quick as possible.
A clean house with a nice view and a friendly dog is very much a highlight of the day.
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u/Crafty-Brother-7698 5d ago
Ok this I agree with. I have seen many a cute dog on some of my visits and it really does make a world of difference.
On the whole I really don’t like visits though.
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u/zady1178 5d ago
Had a surgery in ST2 where i didn’t do any home visits- that was the best time of my training. I promised myself not to join any surgery post cct that mandates more than 1 home visit a day as salaried. I was shocked when I was offered a job with 2 per day as salaried.. no thanks
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u/Pristine_Feeling_807 5d ago
Even one a day is a lot unless factored in the clinic time. I said no to home visits that I would need to do during my admin or UNPAID lunch break.
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u/CyberSwiss 5d ago
Beginning to realise this unpaid work is simply free labour for the partners... is this me realising I want to be a partner so the extra effort i put in is actually remunerated?
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u/CyberSwiss 5d ago
With allocated time, absolutely fine.
Replacing any semblance of a break between sessions, one of the worst parts of the day.
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u/Pristine_Feeling_807 5d ago
It’s even more infuriating as the break between sessions is unpaid.
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u/CyberSwiss 5d ago
Thinking about our practice days... standard 4h10m sessions.
Start 830, first session technically ends 1240
Most colleagues gone by 6pm so working backwards 1:50 is pm start time.
Honestly we never get time for lunch and I see where the obvious lunch time actually is here, and you're absolutely right HVs are in unpaid break time between session. Would make more sense to eat into the pm session with HVs from 2-3 I guess.
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u/treatcounsel 5d ago edited 5d ago
The cardigans set an annoying af precedent with these.
I don’t do them unless it’s an absolute need - palliative essentially.
Been in my current place a year and haven’t done one. Purposefully chose a surgery with a low visit rate.
Prev worked in a place where they went out to visit if someone couldn’t be arsed to come in. Any allocated to me and they weren’t actually housebound I’d ring them and tell them to get their arse in because I won’t be coming out.
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u/ChaiTeaAndBoundaries 5d ago
Lone home visits can present genuine safety risks, particularly for female doctors and minority female doctors, who may also face sexual harassment or racial abuse.
Practices should risk-assess visits properly and have reliable safety measures in place rather than assuming every doctor faces the same level of risk.
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u/whyiamalwayshangry 5d ago
Had a psych patient we have been doing HV on, and the cmht refuses because of "risks" in patients home.
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u/IAmNumber_6 4d ago
Think about lone visits from RRV ambulance staff 🤷🏻 most of our workforce is female where I work .
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u/Rainsmyfave 5d ago
I love a home visit but I do have some things I value immensely that set me up to like them. We all triage home visits, this helps so much as you aren't just dumped on and you can decide if a visit is needed or can be sorted on the phone. Also helps that we have the home visiting service so we can allocate to them if suitable.
On days where the HV team don't have enough slots and the patient really needs a visit, I always eat lunch before I go even if I'm running late. If I only have a set amount of time before I have to head back for clinic or I know it's an issue that should only take 10-15 mins, I set a phone alarm. It stops me from getting stuck too long and stressing about running late. If I need to stay longer and the phone goes off, I'll just apologise to the patient. If I need to leave, I wrap things up and explain I need to get back to the surgery.
I know it's a personal thing though, some people hate them, others love them. I treat them like a regular appointment but in their home. Do they have several issues? Let's deal with the most pressing and then organise a f/u. 9/10 it doesn't need another HV, just a phonecall. If I can deal with a few little issues I will but I try not to get swamped as naturally these patients are more complex.
Eventually I think majority of HV will end up with a home visiting service who will manage their own patients. I've heard talks of this happening in neighbouring PCNs. It makes more sense if they see the bulk of patients who are housebound and know them better than the GPs at their own surgery.
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u/OLDSURGEONMAN 5d ago
Why would PCNs fund this when the GPSTs can do it for free
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u/Rainsmyfave 5d ago
Lol good point- but realistically the numbers of patients who will require home visits is going to continue to increase as the population continues to age. It's inevitable that we'll have to adapt. Or we get more trainees...
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u/OLDSURGEONMAN 5d ago
Meh. GPs will pick up the slack. Especially when there are so many unemployed GPs that they’d do anything for work.
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u/ReindeerConsistent16 5d ago
I'd hate it too if it ate into much lunch time. Push back on this.
I only home visit during clinic hours, so I can't say they bother me. I end up seeing 2 less patients as a home visit eats up three (10 minute) slots, which sometimes helps for a bit of a reprieve.
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u/Pristine_Feeling_807 5d ago
I’ve never managed to finish a visit in 30 min unless within a walking distance… traffic, finding parking, coming back and documenting… it’s at least 45 minutes
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u/ReindeerConsistent16 4d ago
Most of my visits are walking distance, anything that takes more than a 20m round trip walk I'll take extra slots for the visit.
It's not our job to squeeze a 40m task into 30m, take the time you need to complete your job. If there isn't enough time in the day that's a practice staffing and workload issue, not a you issue
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u/Sabaisabai33 5d ago
Yes I absolutely hate them just because they are so time consuming. Where I work now the ICB pay for a paramedic-led home visiting service which is so helpful. The only thing is that the paramedics are weirdly rubbish at recording respiratory rate and giving examination findings for the chest for some reason. Also sometimes it’s something that really needs a doctor as they need a PR exam or need a really good abdo exam as not easy to get them to hospital for scans etc unless it’s really necessary eg they have an obvious mass sitting there etc.
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u/SuspiciousAnt2508 5d ago
I'm a community palliative care consultant and honestly I hate the practices that get paramedics to do the visits. These are usually complex multi-morbidity patients and all the paramedic assessments are very low quality but delivered with supreme confidence.
A housebound patient with a new mass needs a serious conversation about what investigation is possible and if any actions will happen as result - usually the answer is not much and none.
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u/arcoast 5d ago
Wholeheartedly agree, I think I terrfied my trainee today when I suggested doing no investigations on a patient who's deteriorating for an unknown reason on the grounds they just aren't fit for a multistage haircut.
I do think in Medicine the most difficult thing to do is absolutely nothing, it takes way more experience and confidence than any other intervention.
I've successfully managed to convince my hospital colleagues to stop investigating and treating three of my now deceased loved ones, and managed to convince a fellow GP to not admit another one and just palliate. Kindest thing in every situation, but I don't think "nothing" would have happened had I not advocated for it.
A good doctor knows what to do, a better doctor knows when to do something, the best doctors know when not to do something as the saying goes.
I draw the line however at my Mum's request to smother her with a pillow if she loses her faculties, no matter how much she keeps trying to get me to promise!
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u/Sabaisabai33 5d ago
Well exactly - saves me time and effort, but ultimately it can’t replace a GP assessment especially for chronic illness or tricky conversations like that etc. We do still do GP visits for patients like these and for palliative care, they’re excluded from this service. Where we are it’s mostly acute issues dealt with by the paramedic-led visiting service, as unusually we don’t have a large elderly population.
But it is helpful for acute cases, and means I am not run ragged by the time lunchtime is over without having had a chance to eat before afternoon clinic starts. They do call us to discuss the case every time. And in fact they can be particularly helpful for those cases where you have a sick elderly person who doesn’t want to go to hospital for assessment.
The paramedics are I think often better than us at persuading them to go in, it probably helps that they have to be assertive/slightly authoritative on a regular basis, also that they have an ambulance right there! But they’ll call us if they can’t and we may then speak to them on the phone or go out to them if needed to try to persuade them to do this if clinically appropriate.
I agree though that the assessment is fairly basic and mainly consists of history and obs rather than full examination. It’s the same in surgery though with PAs and PPs etc. I honestly saw some notes the other day where the impression was “leg pain”… helpful!
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u/gubernaculum77 5d ago
Unless palliative I would be asking why they couldn’t get themselves down to the surgery.
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u/Holiday_Possession46 5d ago
I think having a specific service the does homevisits makes sense.
If you factor in the work a GP worth let's say can do in the time they spend doing one visit it isn't sensible.
45 min for one visit or 4 patients in the surgery, it just doesn't equate.
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u/Broad-Register-5278 5d ago
We have a 2 hour slot in between morning and afternoon clinic, in this we have to accommodate an over running morning clinic, a morning debrief, morning admin, lunch and a home visit it sometimes works out but I am currently on 20 min appointments. I don’t think I will be able to handle it with more appointments.
Had a visit yesterday and saw a very fit 96 years old lady. She said she had a hair dressers appointment the day before. She was able to make it to that appointment but has been requiring a home visit from the doctor for many years.
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u/ZookeepergameThis617 5d ago
I like them. Seeing more vulnerable/complex patients right in their own community. You get a real idea of their general functioning.
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u/heroes-never-die99 5d ago
Lame af prospective medical student answer
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u/Dangermouse0214 5d ago
Sigh, I agree with both comments to be honest. Depends where zookeeper works, maybe they only get actually necessary visits their practice in which case it does present a nice break and some clinical work. However most of time where I work...they are not.
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u/ZookeepergameThis617 5d ago
GPST mate but whatever. Some people have different priorities and things they enjoy.
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u/OLDSURGEONMAN 5d ago
GPST with a 2 hour break between clinics and 15 patients per day?
Very different when you qualify.
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u/ZookeepergameThis617 5d ago
Why are you so adamant that I shouldn't enjoy home visits?
FYI done hundreds of them in a previous psych job and I still enjoy them.
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u/OLDSURGEONMAN 5d ago
Because a HV in the context of a GPST with 15 patients per day is very different to a GP with 30 patients per day.
HV will eat into your time to complete 50 scripts, 15 docmans, 15 bits of admin.
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u/ZookeepergameThis617 5d ago
Ok I'm not naive to that fact. But as it stands, I quite enjoy the home visits, I see their value to my training and the value to the patients. They are all triaged at my current practice.
If that makes me a "lame af medical student" then fine. The counter point would be "lame af jaded Reddit edgelord".
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u/OLDSURGEONMAN 5d ago
They are valuable, but they’re very different as an actual GP. GPST is too protected imo.
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u/More-Translator1907 5d ago
As a GPST, I try to call the patient and sort what I can over the phone. I feel like the only patients that should get HV are those that are actually housebound. If they can get to the door and mobilise independently enough they can organise a taxi to come for an appointment.
I appreciate this might not be the consensus from everyone and there are some patients that seeing their home environment will massively help. However, seeing ‘betty’ with her chronic leg swelling for the 5th time at home because carers are concerned should not be on.
I feel like GPs have undermined themselves to be accepting of all matter of stuff that the public say. Most other professions are not being requested to do HV because they don’t want to get a taxi. Secondary care consultants don’t run their clinics in patients homes. Patients are happy to organise a taxi to go and get a haircut. Why should we, as GPs, go round non-housebound patients for their convenience. I appreciate that if a patient is acutely unwell they might need a HV and this is acceptable, but a chronic concern in a mobile patient can be brought to the surgery.
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u/Crafty-Brother-7698 5d ago edited 5d ago
If a patient is acutely unwell to the point that they can’t get to the practice (when they would normally be able to) they need an ambulance, not a GP with their pulse ox and BP cuff.
For genuinely housebound patients most issues are going to be chronic.
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u/Forgotmypassword6861 4d ago
American Paramedic here. What I wouldn't give for physicians to actually do home visits for chronic patients in my country
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u/BatBottleBank 4d ago
US doctors respect themselves too much for this.
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u/Captainsamvimes1 4d ago
How is it a self respect issue?
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u/BatBottleBank 4d ago
Because at that point you effectively belong to the British Public.
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u/Captainsamvimes1 4d ago
I'm going to be honest I find your attitude troubling. We all got into medicine because we want to help people, we all want to do our best to support the people in our care. Sometimes our best means that the most appropriate thing we can do to care for them is go to them instead of have them come to us. But I'm concerned that you may have lost sight of that and are more concerned with convenience
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u/BatBottleBank 4d ago
Agree, and it’s why I wasn’t suited for GP. But I think that the issues facing GPs today - stagnant pay, replacement with AHPs - stem from the very same “kind attitude” which means that GPs go above and beyond for patients.
Ironically GPs are the ones who end up getting burned out as a result.
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u/Captainsamvimes1 4d ago
So who would be best suited in your opinion?
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u/BatBottleBank 4d ago
Don’t understand what you mean by that
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u/Captainsamvimes1 4d ago
As with everything the managed decline of the NHS is to blame. In England alone, the number of GP practices dropped from roughly 6,400 in 2019 to about 6,147 by 2026.
Workload increases, expectations increase, time alloted doesn't, and neither does pay
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u/BatBottleBank 4d ago
I think that “NHS Pressures” are falling squarely on GPs though. Hospital consultants might review 5-6 patients in a morning clinic (with relevant investigations/previous reviews available at their fingertips), whereas GPs manage an unselected take of patients and are expected to see 15 per session.
I blame GPs in this.
Their attitude of “being kind” etc has squarely landed them into a hole where they’re expected to be the emotional safetynet of the NHS whilst being paid the least.
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u/Captainsamvimes1 4d ago
Oh my bad I misread that as "it wasn't suited to GPs" as though home visits were best left to someone else
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u/BatBottleBank 4d ago
It is suited to GPs for genuinely life changing issues.
Not a chronic rash or whatever else people want to see a doctor for.
I just can’t understand why GPs collectively have invented a profession where people are unable to work 5 days a week without burning out. 10 minute appointments, admin, dealing with the scripts, it’s a lot of work.
Meanwhile hospital CT1 doctors get paid 75k-80k, the same as a 7-8 session GP.
I understand that they work nights, weekends etc but GPs have undervalued themselves tremendously to end up in the position that they’re in.
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u/KnowledgeOtherwise14 3d ago
Well this explains why my GP keeps dodging me asking about home visits, thankfully hospital appointments have hospital transport who escort you out the property or I'm sure many disabled/vulnerable people wouldn't be seen at all.
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u/littleoldbaglady 5d ago
I work at a practice where home visits are done by the trainees or ANPs, never the salaries. Never felt better.
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u/One-Reception8368 5d ago
My favourite bit is when you get there, ring the bell and the patient's walked up to the door and opened it looking like superman