GP Foundation Programmes in Severn - Home Visiting

Guidance on Home Visiting for F2 Doctors in General Practice

Home visiting by general practitioners is an important feature of British general practice. Home visits represent 10% of contacts with general practitioners although the rate of home visiting has declined over the past 30 years.

The average annual home visiting rate is 30/100 patient years, with the majority in the elderly (300/100 over 85 years).

What are the commonest diagnoses on home visits?

The commonest diagnostic group is disease of the respiratory system. In the elderly disease of the cardiovascular system is also a common diagnostic group.

Is there a risk to the GP?

Visiting patients in their own homes by a lone doctor exposes that doctor to the potential but small risk of injury due to a violent patient or relative, or of injury whilst travelling in the community. However, most reports of violence against GPs occur in the surgery as opposed to home visiting. A number of factors increase the risk of home visiting including type of accommodation, locality, time of day, history of alcohol, drugs or violence.

What about clinical supervision?

Access to clinical supervision during a home visit is can be overcome by a graduated introduction to visiting, use of mobile phones, and detailed discussion after the visit. GP trainers will only allow F2 doctors to visit alone when the trainer is satisfied with clinical competence and a careful selection of appropriate visits.

Foundation Doctors

Home visiting provides an opportunity to gain experience in many of the Foundation competencies. It provides useful patient contact in the areas of respiratory disease, circulatory disease, infections musculoskeletal disease, and pain management.

These patient contacts provide useful material for case based discussion, or direct observation of procedural skills. They also allow the trainee to see the environment in which the prescribed care will be delivered.

Three areas need to be considered:

• the clinical competence of the trainee
• clinical supervision, and
• the risk of injury to the patient and the doctor.

Clinical Competence

It is recommended that all foundation doctors gain competence by making home visits during their GP attachment. Early in the attachment the foundation doctor will accompany the GP Trainer on home visits, and later be allowed to visit alone.

Clinical Supervision

All visits will be screened by the GP trainer as suitable and within the competence of the Foundation doctor. The doctor needs to be briefed before the visit, and debriefed afterwards. At all times both the trainer needs to be contactable by mobile or telephone.

Risk Assessment

Where a medium or high risk is identified, then the Foundation doctor should be accompanied by another doctor or security personnel. In some practices, it may be unsuitable for the foundation doctor to undertake any visits unaccompanied.

Recommendations:

• All Foundation doctors should gain experience of home visiting during their GP attachment.
• The number of home visits undertaken will normally be 1-2 a day.
• The GP trainer is responsible for assessing the suitability of the visit for a foundation doctor in terms of clinical competence and personal safety. Only visits deemed to be "low risk" and within the doctor's competence are suitable for foundation doctors.
• The GP trainer is responsible for making arrangements to brief before, provide clinical supervision during, and debrief after the visit.
• The Foundation doctor needs to ensure that s/he has motor vehicle insurance that covers him/her for business purposes.

 

Adapted from a West Midlands document by: Michael Harris

Last update: 05 April 2009