or was the doc right to refuse a home visit?

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OK, so today my youngest (7 months) daughter's temperature kept spiking up to 39.5-40C and calpol was only keeping it down for about 2 hours before it started to rise again. She's also got an awful cough and cold which has been ongoing for 2-3 weeks, but today was the first time her temp has been bad. Normally I would call the docs and ask for a same day appointment and then drive down whenever the appointment was. Unfortunately that wasn't possible today because yesterday I fell on the stairs and ended up in hospital. Nothing broken thankfully but I have bruised my ribs and some muscles in my back so am unable to drive. TBH, I am struggling to move at all and even holding the babies is incredibly painful, so getting the buggy out and walking the 40min walk to the surgery with 4 kids was just not an option either. So anyway, I phoned the docs, explained the situation and asked if we could have a home visit. They said "no" because they "don't do home visits for babies". They said my daughter did need to be seen though so I would have to work out a way of getting there. I explained that it just wasn't possible as I couldn't walk or drive, I have no family who could take us, none of my neighbours have a big enough car to take me and all 4 of the kids and my husband works an hour's drive away from home (depending on traffic) and was uncontactable anyway because of meetings. They still refused because they "don't do home visits for babies". I had no choice but to wait until my husband was able to answer his phone, which wasn't until 4.30pm so he wouldn't get home until after the surgery was closed, and then when he got home we had to phone NHS24 and he drove 40 mins away to the out of hours doc at 6.30pm with exhausted daughter whose temp was spiking again. They're just home and she has a chest & an ear infection. She's gone through an extra 6 hours pain because doc wouldn't come out to see us and we've also had to take up a valuable out of hours doc appointment when we could have been seen by our own doc hours earlier. so - AIBU to be annoyed by this, or was doc right? Anyone else's doc have a similar policy of refusing home visits on babies?

So hissy you're surely not saying that the solution is for home visits for people with coughs?
Them's the risks of chancing the GP's surgery, innit? Far better to stay at home and dose the symptoms as best you can. There's nothing they can do for flu-type things anyway.

I can see how this was a really difficult situation for the OP - but I do think the GP was right to refuse a home visit.
It would have been easier and better for the OP had the GP been able to visit - but we have limited resources. A home visit to your child would probably have taken a minimum of half an hour compared to 10 minutes in surgery. There is a limited amount of GP time available for visits and allocating it to that child might well have meant that a terminally ill patient waited another day for review of their pain control, or that another 3 people had to wait till the next day until they could be seen at the surgery for their problem - whether that be depression / abdominal pain / breast lump or whatever.
From the OP, the child had a high temperature and was undoubtedly not well - but there was nothing to suggest that they could not wait until the OP sorted out transport which ultimately happened. So I would argue that their needs should not have been put above other patients, which would have happened. Had there been something which had suggested the child simply couldn't wait - like a child fitting with a febrile convulsion or a child who couldn't breathe with asthma then yes, 999 ambulance quicker and more appropriate than GP. This is why in general, I think home visits to children are very rarely justified.
As for the elderly and infirm in waiting rooms - the ones who are really at risk of infections from children are in a minority - e.g. the immunosuppressed on chemotherapy. I think it's far more appropriate for GPs to use the limited visit time there is to see those patients at home than to visit every sick child at home (that would take a very very long time!).

how did you manage to get yourself anf 4 kids to hospital the day before - and back? if you had hurt your ribs

YABU - your baby has a mild temp/cold and cough - that's not an emergency - if it had been an emergency I am sure you would have found a way

your husband can get parental leave

sorry

Whenever I've been in A & E with one of the DCs, I confess to shooting suspicious glances at everyone limping through the sliding doors to see how much blood they're dripping and whether they're therefore likely to leapfrog us in the queue! Can't help myself, sorry!

mama, its about using some parental common sense.

and I am someone who's son has been hospitalised with a febrile convulsion.

Temp of 39+. See if it reacts to paracetemol. If it doesnt, try Ibruprofen. If it still doesnt react, or indeed rises, ring for GP. If GP unavailable, go to OOH/Walk in. Of course if it continues rising go to Urgent Care Centre. If child becomes unresponsive, A&E. Only the very last should need an ambulance, if at all. And the chance of it getting to that stage is very slim. Parents who call ambulances or visit A&E at the first point are not doing themselves, their children or the NHS any favours.

Clam I think we all do that - its natural!

This family were very vocal though is saying that as they were there first they should be treated first. You could hear DS struggling for breath from quite a distance so they could clearly see he needed seeing straight away!

Oh, and should clarify, that's being in A & E for broken bones, invariably. And a split-open-to-the-bone chin from a bike fall. And a meningitis-type rash. Not a temperature.

Sirzy, perhaps they couldn't read? There are signs up all over the place in ours, saying that people are seen in order of urgency, not arrival time.

A mum I know was standing at a bus stop. Her baby was grizzling and feverish, but she just put it down to a bad cold. She was just popping out to the shops, and as she waited for the bus, a lady aproached her and told her to take her child to A & E urgently. She happened to be a nurse. Turned out the baby had meningitis, and is now severly and permanently disabled as a result.

No doubt the mother thought "I won't bother the doctor. It's nothing. Get a grip". If she hadn't bumped into a random person who happened to be a nurse her child would have died. If she had erred on the side of caution and taken her child to the doc earlier, who knows? Maybe her child would not be confined to a wheelchair.

I have worked in A&E.

I now work in primary care.

A large proportion of attendees to A&E are there inappropriately. Their problem is neither an accident nor an emergency. Many will have attended rather than going to see a GP, walk in centre, OOH service or pharmacist.

I completely understand why an anxious parent would use a service inappropriately but unless they stop, think and stop using A&E as a drop in GP-bypass service it's not going to get better, and wait times will get worse. Making an emergency appointment for a chronic problem is not best use of their service and lengthens routine appointment waiting times. Home visits for social reasons (and not having a tenner spare for a taxi, as hard as it is, is not justification for a home visit) and so as not to inconvenience friends, husbands or relatives is not acceptable or sustainable.

If any parent came dashing in to our surgery with an ill child for eg having an asthma attack, or floppy and unresponsive, then they would be dealt with immediately regardless of appointment availability. We're not A&E but can manage the situation until the ambulance gets there.

The days of primary care Peak Practice-style are long gone. With only the sickest patients being admitted to hospital, most chronic diseases being managed by the GP surgery and an increasingly aged, sick and elderly society I'm afraid patient expectations are going to have to change.

hissy, a friend of ours is a GP who was the 3rd one the mother had called and he agreed to a home visit. when he arrived at the house the downs syndrome girl was dead, 2 other GP's had refused to come out to the child that night.
Now I would drive to A&E if I was concerned without a moments hesitation, because the staff cannot ignore you if you are under their noses rather than on the other end of the phone and not in the mood to come out.

Our GP routinely does home visits after morning surgery finishes and then again after the afternoon surgery.

Our Drs is open from 8am till 12pm. Home visits for an hr, afternoon opens from 2pm until 7pm and then an hr of home visits again.

We do live in a village and our GP surgery covers our village and the next one. We have 2 full time drs & 1 part time.

I've had to call out the GP for home visit once for me which was no problem. I do feel very sorry for the OP, she had awful circumstances to cope with. It is also sometimes very difficult for dh's to get away from work if they work in certain careers.

I would also worry that a baby who had been unwell for 3 weeks already and had developed such a high temp would be classified as an emergency visit. Home visits usually do not occur during normal surgery hrs but afterwards so other patients won't be affected.

Anyway OP I do hope that your dd is better soon

unfortunately home visits are rare now primarily for the time factor as explained numerous times above.. I have done home visits for the housebound to make new dentures its 4-5 home visits at between 45mins in town and upto 2 hours if rural would be 4 x 10-15 mins in surgery, so for 4 visits could have seen between 8 and 25 extra patients, now they use outpatient ambulances to bring patients in, the other thing is that even if its a home visit you are expected to have the same emergency equipment as in surgery so even as a dentist it meant taking an emergency drug kit, oxygen cylinder etc in your car loading them into house the removing them again after visit, which means you need 2 sets as obviously the one in main surgery has to stay there.
In many towns and cities out of hours clinics have replaced home visits because of the number of attacks on GP's to get their emergency drugs etc so then they used a GP and a driver so the car was not stolen damaged but then they moved to clinics it is in patients best interests as will get better treatment though not always as convienient

on the more amusing side some patient asked for a home visit as she had toothache on a saturday morning ( she said she didn't drive but was on bus route with hourly service) but apparently to quote " she did not believe in buses" was offered appointment about two hours later but was very annoyed that her son had to interupt his day fishing to bring her! my GP friends could come up with many many stories including being asked to find cat as if she did not the patient would have hysterics then would have to go anyway

OP, in an emergency you do not car seats in a taxi or even in a friends/neighbours car, I do understand your frustration but you will need to think of a plan B, ( in scotland if you kept receipt depending on income the taxi may have been paid for) but hopefully it will not happen again and your child is on the mend now, I live in rural scotland 30mins walk to GPbut the next GP is a minimum of 8 miles away ; 34 mile round trip to out of hours GP 65 miles round trip to A&E

Slightly OT but the last time I went to A and E was because our doctor wouldn't see ds. He was post op and had an infection, was already on antibiotics but was on the last day of the course and suddenly got very poorly and his op wound looked extremely nasty.

I spoke the the GP in the morning and asked to bring him down and was told the GP would phone me, which he did but it wasn't until the afternoon by which time morning emergency clinic was over and the GP decided that ds didn't need to be seen. I explained how serious ds's wound looked and how it was getting worse literally every minute and he just wouldn't give me an appointment - told me as ds was on antibiotics he was ok.

I waited an hour in which time ds was a lot worse and I phoned NHS direct and they told me to take him to A and E.

Ds had a secondary infection and needed new antibiotics and was really poorly for another 2 weeks.

I do understand people going to A and E if they can't be seen by their GP's. I think if GP's appts were easier to get and there were more walk in centres ( there were lots were I used to live but only one out of hours place here) then perhaps it would free up A and E.

IME there are some people who urgently need seen but are worried about bothering the dr and others who demand urgent care when they don't need it. Just a general observation not referring to anyone on the thread.

For a temperature with a child I would follow what smokinaces posted. If I did see a child who was any of the following: floppy, unresponsive, cyanosed, aversion to light or a mengicoccal rash then I would not hesitate to call 999. In these circumstances I am sure the staff in A&E would be happy to see them for it to turn out to be a false alarm, ie well intentioned. A big difference from having a sore throat for 20minutes dialling 999 and demanding an ambulance (which yes I have seen). As an aside I don't know about all ambulance services but some will pass calls over to the ooh service for assessment if it is obvious to them

OP it was a very difficult situation for you but I do agree that your dd would have been seen at the surgery. I do sympathise I had to walk 40minutes to the surgery just after I was discharged after a C-section. It was a struggle getting the pram up and down kerbs but unfortunately you just have to do it. I hope your dd is better soon.

lequeen I did wonder that when I read at first but on thinking about it I suspect it was more likely the nurse noticed signs of an aversion to light and movement that suggested neck stiffness rather than the temperature.

The "woman at the bus stop" story is only relevant to this thread if she was on her way to the GP surgery having been refused a home visit.
(not meaning to disregard the tragedy of the case however)

OP for future reference if you are using a taxi then you don't need to use a car seat for any child UNDER the age of three. I've read the law inside and out on this as we don't have a car and are too tight to buy a child seat and wanted to make sure we knew our position. But hopefully, as you say such a horrid combination of circumstances won't happen again. Hope your DC is feeling a bit better.

I would be mightily pissed off if my doctors appointment was delayed because a doctor had to go out to a baby with am ear infection - if you were so bad why the hell did your husband go into work?

Imagne if all doctors succumbed to mothers insisting that they have a home visit we would spend our lives sitting in doctors waiting rooms when all that was needed was a cours eof anti biotics.

You should never call an ambulance for something like this.

I think that you are being unreasonable, I understand you are having a hard time with a poorly baby and your injury but you still got her to the doctor in the end.

Your child is portable and as others have said taxis are available. I have had an instance where the doctor will not do a home visit for my 93yr old grandma who is on end of life care, she most certainly is not portable.

I hope that you dd gets better soon

I've heard the nurse at the bus stop tale so many times and I'm sure it's an urban myth.
I mean how can you tell by looking at a wrapped up child in a pushchair it has meningitis when hospital; doctors need a lumbar puncture?

"how did you manage to get yourself anf 4 kids to hospital the day before - and back? if you had hurt your ribs"

Good point, Gordylovessheep! How did you manage it OP?

I think YABU. At the end of the day, your DD is ok and it turns out she could wait to see a doctor. If ever a child is so desperately sick that they cannot wait 6 hours then surely they would need A&E. In which case they'd wait another 6 hours anyway to be seen.