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ASHCROFT LEADS
- Doctor: Drs Ramesh Mehay & Sudhir Krishna
- Nurse:
- Admin: Vicky O’Shea & Chris Rushton
DATE REVIEWED:
21th July 2022
DATE OF NEXT REVIEW:
21st July 2023
The Policy/Protocol
There will be a ‘visits surgery’ on SystmOne for each day – where admin staff can log all requests for home visits. It will be up to the doctors to triage and decide which of these patients actually requires a home visit and by whom.
ALLOCATING VISITs
On Call Doc
The on-call doctor will be ultimately responsible for ensuring all home visits have been allocated. Please allocate visits before 1130 so that other docs can go off on their visits when they finish their surgeries and are not kept hanging about.
Once the doctor triages there are 4 options
- Visit not necessary – sorted over the phone
- Visit necessary – if simple – email sent to PCN HOME VISITING TEAM to do: housebound.team@nhs.net
- Visit necessary – if more complex (e.g. palliative care, mental health) – one of Ashcroft Doctors to visit (including trainees)
- Visit necessary – patient with long stranding problems – consider Community Matrons to do.
Other Considerations
- Allocate to trainees first. Maximum 3. On Tuesdays & Wednesdays – maximum 1 (they have HDR and Weds Tutorials to get to). It is important that our trainees get exposure to Home Visits – otherwise they will never get skilled in this area. If a patient is too complex for a trainee, move to a more experienced doctor. The average home visit itself should take about 15 minutes to do. Initially, trainees may be taking 30 minutes a visit but they should be able to whittle this down to 15-20 minutes as they become more comfortable in the process. If they are taking longer than this and have been in the practice for more than 3 months – I suggest a tutorial with their GP trainer.
- After allocation to trainees, try and allocate ACUTE visits to other qualified doctors evenly. So, even if a doctor has put themselves to review a patient, the acute ones get distributed evenly. (UNLESS a particular doctor has stipulated something like “max 1 visit for me because I have a meeting at 12 noon).
- Also worth considering when allocating acute visits is to look briefly into the record to see which doctor knows them best; this will help promote continuity of care. It will take an unfamiliar doctor perhaps 40 minutes to sort out a complex patient yet a familiar doctor would probably sort them in 15.
- Other Working Docs – this does not stop you from allocating visits to yourself. Please periodically look at the acute visit list and assign yourself to someone you know.
THE HOME VISITING TEAM
ACCEPTABLE LIST
- Chest infection
- Urinary tract infections
- Falls
- Trips
- Ears
- Throat
- Skin conditions-rashes, shingles
- Eye problems such as conjunctivitis.
- Diarrhoea and constipation but not an acute abdomen.
Email: housebound.team@nhs.net
EXCLUSION LIST (temporary)
- Multiple complaints with co morbidities
- Palliative and EOL care.
- Under 18s
- Pregnant women
- Complex mental health issues
- Long term conditions – could these be directed to the community matron service?
IF FOR ANY REASON YOU CANNOT DO A VISIT
- Please put something like ‘DR XXX – no home visits, IT meeting’ onto the home visit list; i.e. your name, ‘no home visits’ message, and concise details of why you can’t do visits.
- If you know in advance you cant do visits, please log this onto the visit screen in advance too – DO NOT LEAVE IT TIL THE ACTUAL DAY.
- If you do end up leaving it til the actual day, please see how many docs are actually around to do visits in your absence. If it is low, is it possible you can take at least one visit? If so, write something like… Dr YYY (1 visit max, CARE meeting). You may need to liaise with the on-call doctor.
REDUCING THE NUMBER OF UNNECESSARY VISITS
Consider telephoning all your visit requests before going out to see them. You will be surprised how often you can manage someone over the phone. For example, a patient with recurrent knee pain already on tramadol 1qds and known to have OA, might just need the tramadol increasing to 2qds if the pain is continuing rather than visiting acutely.
ACTIONS FOR ADMIN STAFF
- EVERY MONDAY – log onto each home visit screen for Mon-Fri of that week and list which doctors are available for visits for those days. A list of usually available docs is available at reception – but check who is on leave.
- Add home visit requests before 1130 to the home visit list in SystmOne.
- For all patients requesting a visit, please encourage them to come down to the surgery. If they can’t come down ask why.
- Please take a look at the home visit list at 12 noon to ensure every visit is allocated. If any are not, please contact the emergency oncall doctor for that morning ASAP.
- For home visit requests after 1130: please inform the morning emergency duty doctor who will then hopefully triage the request and decide whether or not it is appropriate and when the visit should be done.
IF YOU ARE PUTTING A PATIENT DOWN FOR A FUTURE HOME VISIT REVIEW
Carefully consider whether a home visit is necessary – only you can decide. But in many instances, a telephone follow-up call in one of your routine surgeries might be an alternative. If you do put down a face-to-face home visit review – make sure you put them on the list for a day when you are actually going to be in surgery. And make sure you put your name down next to the review eg. Review Breathing (Dr. Hamblin).