GPs should do more home visits, not fewer
Persuading a doctor to visit you at home nowadays is fraught with obstacles, however ill you might be. Such is the reluctance of GPs to come and see you that you will end up having to get to the surgery somehow, or else head for A&E and take your chances there. Last week, a national conference of GPs voted to scrap home visits altogether, describing them as an “anachronism” that should not be part of their core work. For the frail elderly, anyone living alone, or parents of young children, particularly those unable to afford a car, the end of home visits is a very worrying prospect.
Have GPs really so lost sight of their role that they feel able to describe this part of their work as a “waste of time”? In an age when almost every consumer item can be delivered to your door, it is extraordinary to think that the one service that you really need to receive at home could soon be consigned to the past.
A GP’s waiting room these days is no place to be ill: full of feverish children crying, adults coughing and sneezing, queuing for hours to be seen for five minutes (if you are lucky). That such a system has been allowed to develop is surely a terrible reflection on the priorities of the NHS, where services seem increasingly geared to the convenience of staff rather than patients.
As all political parties vow to spend billions on the health service, it is worth considering what happened when a large pot of money was last offered to GPs, by Tony Blair. Fed up with a long hours culture, and struggling to meet the demands of an expanding – and increasingly elderly – population, family doctors negotiated a new deal that paid them better while relieving them of out-ofhours work. So began a trend away from a personalised service where GPs had a holistic picture of their patients’ needs, to be replaced by a box ticking, target-led and surgerycentred business.
If this latest proposal is agreed, any home visits will have to be dealt with by a separate NHS service rather than by local GPs. Not every GP at last week’s conference was happy with the idea. In the words of one of those opposing the resolution, “it will disrupt fundamentally the relationship that we have with patients if they do not trust that when they are older, sicker and more unwell we will still be their doctor.’’
For many patients on the books of large GP practices, who never see the same doctor twice, such trust is already a thing of the past. Enterprising NHS-trained doctors in wealthy neighbourhoods are setting up private practice groups, available to those who can afford to pay a fee. Ironically, these doctors have no surgeries, instead spending all their time on home visits. With minimal overheads, these modernday Dr Finlays are rediscovering the satisfaction of knowing their patients personally.
One of the reasons NHS practices are currently under so much pressure is the difficulty in recruiting newly trained doctors to this branch of medicine. Yet if GPs now abandon home visits, they will be losing a task that lies at the heart of the doctor-patient relationship, giving purpose and meaning to their role. Any new government settlement for general practice needs to place more emphasis on that relationship, rather than whittling it away further.
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When exactly did it become a rule on the Left that anybody who disagreed with you was evil – not wrong, or misguided, or ill-informed but purposefully wicked? Actually I believe I know the answer to this. In fact, I think I was there when it happened. There was a seminal moment that I recall vividly when my generation at Berkeley was engaged in creating what would come to be known as the international student revolution. Our protests then were against the Vietnam War and the official racial segregation maintained in the American South, as well as the unofficial segregation that persisted in the North, which was particularly redolent in the neighbouring city of Oakland.
In the early, formative days of that movement, an under secretary of state from Lyndon Johnson’s administration came to campus to defend the military action in Vietnam. It was generally assumed, in those innocent times, that such a distinguished visitor would be received with polite attention. There was no such thing as “no-platforming”