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GP mythbuster 71: Prioritising home visits

Categories:
  • Organisations we regulate

It is good practice for GP practices to have systems in place to triage and prioritise home visits.

Since the coronavirus (COVID-19) pandemic, the need for a home visit should be continue to be carefully assessed. The British Medical Association (BMA) and Royal College of General Practitioners have published COVID-19 Workload Prioritisation Unified Guidance which explains response levels. The guidance outlines types of work that should be undertaken in primary care, depending on:

  • COVID-19 prevalence
  • other workload
  • workforce factors

The British Medical Association (BMA) has produced a COVID-19 toolkit for GPs and GP practices.

NHS England issued a patient safety alert to raise awareness of the need to have a system in place to assess:

  • whether a home visit is clinically necessary, and
  • the urgency of need for medical attention.

The alert states that:

"This can be undertaken, for example, by telephoning the patient or carer in advance to gather information to allow for an informed decision to be made on prioritisation according to clinical need. In some cases, the urgency of need will be so great that it will be inappropriate for the patient to wait for a GP home visit and alternative emergency care arrangements will be necessary."

"Many practices will already have systems in place to manage home visits. Where this is the case, consideration should be given to whether a review is required in light of this alert. The review should also consider whether all clinical and non-clinical staff involved in the process are aware of their responsibilities when managing requests for home visits, and if any outstanding training needs exist.”

GPs should also consider whether alternate ways of assessing the patient are appropriate. For example, video call, telephone calls or the use of virtual wards in care homes.

When delegating home visits, the provider must ensure that the Health Care Professional (HCP) has the necessary:

  • skills
  • knowledge
  • competence and
  • training to deliver the home visit.

The HCP should also receive appropriate supervision and support from the clinical team. Practices should ensure that the person allocated is competent to carry out home visits.

When we inspect

We will expect to see evidence of how the provider has assured themselves of the capability of non-medical HCPs, to whom they delegate home visits. This should include a process of assurance: both on initial delegation of the role and how the HCP’s capability is maintained on an ongoing basis. It should include audit of:

  • their clinical decision-making
  • prescribing decisions when relevant and
  • a system for escalation to a senior clinician when necessary.

We use these regulations when we review if the practice is safe, effective, responsive, caring and well led. This mythbuster relates to:

It is part of our key lines of enquiry (KLOEs). One of our key questions is whether services are organised so that they meet people’s needs. In particular, KLOEs:

We may look at how the practice:

  • manages and prioritises home visits
  • recognises a deteriorating patient
  • works with other professionals
  • manages care planning, referrals and investigations.

We may also look at:

  • the practice’s processes and systems to monitor patient safety through reporting patient safety incidents
  • how they learn from these incidents and significant events.

This patient safety alert shows how important it is for GP practice staff to report all patient safety incidents to the National Reporting and Learning System (NRLS). Lessons can be learned across general practice.

Further information

Last updated:
25 May 2021