to stay home rather than trekking across the city with DS3 to see a doctor? (Long)

[BoffinMum]

DS3 (age 3) has a kiddie virus, all the usual symptoms, but with the slightly concerning addition of ice cold feet, so I looked on NHS Direct for advice. He does not have a headache and he can look at light, so I wasn't hugely worried, but I thought I ought to take it reasonably seriously, considering the cold feet thing. NHS Direct advised me to ring my GP, which I did. I have been instructed by the Out Of Hours service to trek across the city with my very sleepy, poorly DS3 to get him looked at, which also incidentally means taking two other children with me (one of whom is knackered and may be going down with something himself) and causing a great faff. I am knackered too, and my SPD is bad today. And they told me that 'illness is dynamic, so even if the GP thinks he is OK during the appointment, you will need to keep him under close observation'.

Here's the thing. I actually want a home visit for once. I don't want to trek across the city in pain, with DS3 in pyjamas and a blankie, and sit around in some remote suburb until some doctor deigns to see me, patronise me and probably just send me to sit at A and E all night anyway, after being triaged by about five nurses, all of whom ask us the same things, before we are sent home at 3am feeling like complete idiots and slight abusers of the NHS.

I know all the arguments about how inefficient home visits are, how greedy we all are for wanting them, how terribly BUSY and IMPORTANT doctors are and how they can't be expected to pander to the social needs of their patients, with all they have to do, and, most crucially, how feckless people demand home visits because they have coughs or hangovers, and ring for ambulances because they have run out of Tampax or whatever. I really do know all that.

But just today, I would really, really like someone to come to have a look at DS3 in his home, in the context of his family, and tell me how worried I ought to be.

That's all. Just one of the six or eight doctors from the local practice to pop up the road and do a bit of a Doctor Finlay.

AIBU?

Totally accept all that you say smileyhappymummy but being courteous and considering the needs of others and acting with a little empathy doesn't actually cost anything. The things that cost are tier upon tier of extraneous management that has done nothing to improve the patient experience or treatment available. Think PCT. Think abdicating common sense. Think the NHS computer. Think 28 day prescribing that wasted everybody's time (in my case for a drug that costs pennies). Think the failure to hire doctors who can understand the English language adequately.

So, because Boffinmums dear old dad works all night so little old ladies can carry on listening to the radio, GP's should do house calls, for parents who want them. Even though this might delay a terminally ill patient getting adequate pain relief, or means an elderly confused patient needs to wait longer. Even though it is not clinically sound practice to see children at home.

Ok then

figwit. I have only one word for you. Holistic. And of course one has to prioritise but there are people with no car, no bus stop within a mile and several children and disabilities who need a home visit for all sorts of reasons.

Glad your son is ok boffin mum.

But the OP has a DH with a car, so why the fuss and need for a GP home visit?

Home visits are for patients with no other options. Clearly not the case here.

I think that in almost every case it is unreasonable to take medical resources away from patients who cannot leave their home, to see patients who can. On call resouces are finite. We wish they weren't but they are, so choices are made.

But it does cost something to provide a home visit instead of seeing a patient at base, because it probably takes somewhere between 3 times and 6 times as long to see a patient at home. Which means you need to employ more doctors to see the same number of patients if you see them at home instead of at a clinical base.

Precisely which is why the waste caused by setting up the PCTs, embarking on and abandoning the NHS computer, and 28 day prescribing (where I had to make an appointment or arrange a repeat prescription monthly for a drug that was essential, cheap and unvarying) are all acts of heinous waste because what has been spent on the unnecessary, ineffective, cumbersome and useless could have been spend on providing medical care, ie, front line staff. What is it that you don't understand about that. 10 forms do not save a life - a doctor's visit might.

And actually it shouldn't take three or six times as long to see a patient in their home. Services are supposed to be local - local doctors knew the needs of their patients. The appointment should take no longer than in a hospital. When I grew up the doctor lived in the next road. The hospital was a 20 minute drive. Disabled mother and three young children getting a cab or two buses at night, in the cold and wet, compared to one doctor getting in a warm car and arriving in a matter of minutes.

It wasn't much fun being the wife or child of a GP in theolddays either, my Mum had to stay on to man the phone and we had to tiptoe around a grumpy tired father, when he was on for the weekend we couldn't go out in case he needed the car. They didn't get paid half as much as GPs do now either.

My GP did a home visit for me a few years ago, on Christmas eve, when I thought 3 day old DS2 was breathing noisily. She was very nice about it.

Even if it's local it could still mean the GP having to travel 5-10 miles between cases. Any travelling by the GP is using up time which could be seeing other people.

Home visits are fantastic for those for whom there is no other option they can't get out of bed and need the care. But for most people there is no reason they can't make their way to see the GP at the OOH centre.

at Gentleness - it's not about the cost to the taxpayer, it's about the fact that an ambulance called out when it's not required takes one away from a genuine emergency.

I'm stunned at the casual "call an ambulance" attitude of some posters on MN and even more at the "go to A&E" whenever a child has a sniffle.

No wonder the NHS is collapsing.

OP, the above is not aimed at you, apologise for hijack and glad your DS is ok.

I accept all of that but I think the NHS has lost sight of the fact that patients should be at its heart. I don't expect a GP to come to me, I did expect my father's last visit to the hospital when it was confirmed he was probably out of remission (acute myeloid leukaemia) three days before he died of an unexpected cerebral haemorrage to have included 30 seconds with a doctor so that a very expensive and unnecessary post mortem could have been avoided. So much money seems to be washed away at the expense of a little common sense.

Um, it was nhsdirect that suggested the ambulance and told me an a&e visit was needed fast, rather than ooh which was what I expected. The nurse was very clear and strongly suggested the ambulance - having tried to get there as I described, even blessed with a car, I now see why. Before that I would have agreed with you.

I did kind of include the taking up of emergency services in saying ' the cost to the taxpayer' - not all about money surely, but perhaps I should have been more precise.

'I think the NHS has lost sight of the fact that patients should be at its heart'

No that's absolutely not the case. There is an enormous amount of dedicated patient care going on. I'm sorry for your bad experience but that is not universal. The service I work in lost a patient this week. I can assure you that the team worked incredibly hard, trying - over years- to keep that patient with their family. I have cried at my desk before now, I go home and cry and then I go to work and try and do better.

No doctor will argue when people say that the layers of ever-changing bureaucracy are a costly waste of NHS resources. But that is the way it is, it's what successive governments have done, and there is nothing us doctors can do about it. We just have to work within the system as best we can.

Trust me, I would happily spend my days having cups of tea at the homes of children with a sniffle, popping round to see dear old Mrs so-and-so just because I was passing, spending half an hour with each patient etc etc. But now we have masses of paperwork to do, literally hours of admin every day. And targets, endless targets. And we have to offer more and more appointments every day, because people have more health understanding than they used to, and greater expectations. And we have more drugs than we used to, and these drugs require blood tests and monitoring, and that takes appointments. And people are living longer, so we have more elderly people with multiple medical problems. And more and more work is being done in the community that used to be done in hospital.

This is not an issue of whether doctors care or not, of whether or not kindness is a thing of the past. It's a simple example of supply and demand. There are only so many hours in a day. If people want more home visits then we need more doctors, which would mean more money being spent on the NHS, which would mean higher taxes. And that's not going to happen is it!

DD used to get freezing hands and feet, that often went an alarming shade of lavender, every time she was brewing a fever. Like your DS they warmed up and turned a normal colour when her temperature rose.

The first time I found it very alarming, and rushed to the Dr, who reassured me. She grew out of it by the time she was about 5 or 6.

I never fussed about a home visit, I just said how much I missed being able to have one for the kids. But let's discuss the politics of this a bit more, and why I think most GPs constitute a glorified guild these days.

FWIW on two occasions, I have been instructed to make my own way to the OOH Centre, once when I had double pneumonia and was so breathless and ill I could not get there, and also when I initially lost the ability to walk, so I am not very sympathetic to claims that people who can't leave the house have access to home visits, because frankly, they don't. DH once had a massive nosebleed, after a sinus operation, and he was supposed to trek across town to this place as well, because the OOH Centre would not fax a prescription for antibiotics to the local pharmacy, and demanded DH picked it up in person instead (note - we weren't allowed to send a proxy, he was not seeing a doctor, he just had to stagger in there himself for administrative reasons). Around here, people just try to manage without healthcare half the time. Particularly tough if you get ill on a Friday at 6pm. Things are not patient friendly out of office hours.

Secondly, the catchment area for my GP surgery is minute. You could probably cycle around it in 20 minutes with the wind against you, or drive it in 10. However they no longer do home visits and have clubbed together with all the other GP practices in about a 30+ mile radius to set up this OOH centre in the middle of nowhere. It still costs a fortune to provide OOH service, except that the expense has more or less been completely outsourced to the patients without any consultation whatsoever. People have to drive up to an hour to get there, sometimes more. Taxi fares to get there and back in the wee hours can be £60 - not an option for some people who have less than that a week to live on. Meanwhile the centre is used by some of the same doctors (who have all gone part time since the pay award) as a private GP centre during office hours - so they have basically managed to do a wheeler-dealer special, building themselves a private healthcare facility with all of the capital cost apparently offset by the taxpayer, on the basis that OOH it is used for emergency consultations. They must think we are completely daft.

Forgive me if I am starting to sound bitter.

figwit my point was that a huge number of other professions and industries just get on with providing a 24/7 service, but many doctors and indeed consultants seem to think they are above this. They have torn up the social contract they had with us, the public. And we don't like it at all.

This question is going to sound naive, but it's genuine.

When I was a child, it was perfectly normal for doctors to do house calls for sick people - they'd do morning surgery, then they'd do their house calls. What changed? It's not just the changes made by the last government about OOH care, because GPs became reluctant to do house calls long before that.

So why did it become so much more difficult? Is it simply increased demand?

Boffin all other professions and industries are paid more during "antisocial" hours. GPs did it for free. We worked all day and got paid, all night for nothing, then all the next day with pay. Show me another industry that does that. Did your father trek out in the snow for zero pay?

And just for the record, it's almost certainly a PCT decision as to which agency covers OOH and where the centre is, nothing to do with GPs themselves.

You are displaying the typical attitude of someone who can't see the bigger picture. You only talk about your own immediate family and how the service impacts on you. You seem to forget that you are one tiny person among many thousands, all of whom have their own different essential needs.

hackmum I would like to know this as well. I've listed what I think to be reasonable criteria in a previous post, and re-reading them, they don't seem very different from criteria when DD was small (late 1980s), where there was a bit of common sense rationing, but there was an element of social concern as well, patients being considered to be more than their diseases.

Drs do provide 24/7 service, they just do it from a location where the resources are easily accessible for them which is much more sensible.

You say you are in a city - could you not bundle everyone in a taxi?

Velma, at the risk of egging you on to greater heights of patronising, the problem is that the nation is made up of 70 million people just like me, and we are effectively your paymasters. I think the turning point for me and a lot of people was the moment when I saw so many GPs able to go part time, after the pay award, which certainly hasn't got anything to do with the PCT.

And yes, if I remember correctly, my dad worked 1 weekend in ?4 as part of his contract. It was really quite often. You could volunteer to do more and then you would get extra pay for that (like a locum), but for the routine shifts, that was part of your job and you got no extra pay (like it was for many GPs in larger practices).

It's the same for a lot of professions.