Zara Aziz: There are valid reasons for a separate contract for care home visits

The recent special LMCs conference may have voted to change contractual arrangements for care home visits, but I remained sceptical until recently.

I also have a confession to make. I like home visits. I have come to this conclusion after slow and painful deliberation over the years. This was not always the case.

There once was a time when the lunch hour was just that - to venture out for some fresh air, perhaps with the receptionists or the other doctors, eat a sandwich, crisps or some fish and chips on a Friday. Home visits were few and far between, Choose and Book had not been invented and patients could still find parking in hospitals.

If perchance you do not get a home visit or two in the middle of the day, and rub your hands with glee at the prospect of catching up with your paperwork, then think again.

You heat your lentil soup in the microwave oblivious to the queue of folk accumulating outside your room. You are the only doctor in the building and by default have become the duty doctor for the scrips, sick notes and abnormal blood results that are called through, plus you have to inspect all the leg ulcers requiring antibiotics in the treatment room. The soup does not look so appetising anymore and the clock signals the start of the afternoon surgery.

I like care homes, so to speak. A visit to one, accompanied by some fresh air, is surely no bad thing. I am told that some care homes even offer lunch and refreshments to their GPs (although I am only ever given urine specimen pots on visits).

But then my resolve gets fully tested - I have an on-call afternoon from hell. Within the space of two hours I get requests for six urgent home visits - all seemingly appropriate - three of which are in care homes.

I run from place to place like a headless chicken. I admit two patients, one with suspected pancreatitis, the other with urosepsis. The remaining four are reasonably well and did not need to be seen, but such is the way with telephone triage.

My on-call proves what I already know: time is the enemy and there are not enough hours in the day for what GPs are required to do. Our workload is mushrooming at an alarming rate.

So maybe those who voted for the motion for separate contractual arrangements for home visits did have a point - it is fine to do a home visit or two in the middle of the day, but another matter entirely if you spend unscheduled hours out of surgery time.

  • Zara Aziz is a GP in Bristol

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