LMCs vote to remove home visits from GP contract

LMCs in England have voted to remove home visits from the core GP contract, arguing that spiralling workload and workforce shortages mean the profession no longer has the capacity to deliver them.

Following a long debate, with many speakers on both sides of the argument, 54% of delegates at the England LMCs conference backed a motion calling for the GPC to negotiate with NHS England to remove home visits from the contract.

Some 74% of delegates backed a second part of the motion that called on the GPC to work to establish a separate acute service for urgent home visits.

Responding to the debate, and ahead of the vote, Dr Julius Parker the GPC lead on contracts warned delegates that the likelihood of the GPC being able to successfully negotiate such a change to the contract was 'extremely low'.

However, Dr Andrew Parkin from Kent LMC who initially proposed the motion said that, even if it wasn't possible to remove home visits from the contract, backing the proposal sent a clear political message.

'We do not have the capacity, we do not have the staff and we do not have the time,' Dr Parkin said. 'It sends a very clear message through to the government that we need help, we need more time, we need more funding and we need to look at how we do that.'

Dr Parkin argued that dropping home visits could free up two or three hours of a GP's time on an average day, which would enable practices to improve care for all patients and allow GPs to choose to see the patients at home 'who we really need to see', such as those at the end of life.

Support for home visits

Delegates speaking against the motion argued that home visits were core to general practice and enabled the profession to provide 'cradle to grave' care.

Dr Sarah Matthews from Coventry LMC said: 'This is a very bad idea. It will sell the heart and soul of our profession away. This will allow people to say of us, "those GPs don’t care about us, they don’t care about us when we’re very sick, when we’re very vulnerable and when we’re dying".

'The idea if we recommission this service away to another team and that they will care more, better than me, than you, who has known the patient for 20 years, is just not true. It will disrupt fundamentally the relationship that we have with patients in front of us if that patient does not trust that when they are older, sicker and more unwell that we will still be their doctor and we will still care for them.'

Dr Annie Farrell from Liverpool LMC said that home visits were 'core to general practice'.

'Far from being old-fashioned they are needed more and more as our patients are living longer,' she added. 'Cutting home visits is cutting to the heart of general practice and what we are here for.'

However other GPs argued that supporting the motion did not mean that doctors would be unable to carry out home visits, but that they should be reserved for those that truly need them rather than being seen as an entitlement.

Workload issue

Dr Brian McGregor from North Yorkshire LMC said that the motion was about workload, adding this was the profession's opportunity to stand up and say 'enough is enough'.

'I want to speak about colleagues who are literally dying on their feet or taking their own lives because they cannot cope,' he said. 'Are we sending the message that we will maintain ourselves as a sink hole for everything in the NHS, that we will take it all on board, that we will be the Superman contract?

'This is about workload. When do we say to the 40,000 other GPs out there that we are going to stand up and tell the government that we’ve had enough and say we can’t do this any more?'

Dr Anthony O'Brien from Devon LMC said the motion was a chance to 'draw a line in the sand'. He argued that many home visits were related to patients being discharged early from hospital.

'There’s nothing wrong with the idea of discharging patients early, but it is the biggest transfer of care from secondary to primary care that we’ve ever seen,' he said. 'Patients that come out earlier are sicker, there are more of them at home and that means more work for us. More work, but no more money.'

Delegates at the conference described the motion as 'difficult' and said the result demonstrated how much pressure the profession was under.

The motion in full

That conference believes that GPs no longer have the capacity to offer home visits and instructs the GPC England to:
i. remove the anachronism of home visits from core contract work - backed by 54% of delegates
ii. negotiate a separate acute service for urgent visits - backed by 74% of delegates
iii.demand any change in service is widely advertised to patients - backed by 90% of delegates

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