GP home visits - do they happen any more?

[pooka]

Hi all - just hoping for views about a situation we have with my grandmother.
Background - she is 90, very frail, has carers 3 times a day (to get up, give her lunch and then put to bed) so she can stay in her own home, where she has lived for 60 years.
She at least a 2 hour journey away from all of us.
Her physical and mental health has grandually deteriorated although she is still able to remain in her home at the moment.
However, she has had several urinary tract infections in the last year. But her doctor has refused to visit her - says home visits aren't done. Recently her carer picked up on change in her urine and called my mother who rang the surgery. The practice nurse said that she should get a sample, put it in the fridge, and then the nurse would come later in the week to pick it up. In the meantime, a filled presription of antibiotics was dropped through her letterbox. Bearing in mind my mother lives a good 2 hour journey away it was a bit tricky getting the sample, but has been done.

However, last night she had a fall Ambulance was called by the morning carer, they checked her over, didn't take to hospital but warned her blood sugar was low.

Sorry for the ramble, but the query really is whether you think it is reasonable to DEMAND that a doctor from her surgery makes a house visit, bearing in mind it is not possible for her to be taken there during the week, no doctor has seen her for 2 years 4months (and several prescriptions have been written without ANYONE seeing her - just phone advice). My mother is going to call in the morning, but she fears she will be fobbed off again.
I would appreciate your views as to whether you think she is getting appropriate GP support - not to criticise the GPs but more to know whether you have the right to home visits where you are housebound for example.

bumping!

Well I,m not sure about "rights" as such but my grandmother is in her 90's, lives independently within a sheltered type of accommodation, and yes, her GP does visit when she is unwell.

Tbh I think what you have described is disgraceful.

I would suggest your Mum asks to speak to the practice manager at the surgery, NOT the GP, and asks for the home visiting policy to be explained to her.

my neighbour's elderly father lives with them, i know the GP has made a home visit on several occasions when he has been too frail or unsteady to be taken to the doctors...

it is absolutely reasonable under these circs for a home vist and some support

Hi, my DH is a GP and does about 3 home visits a day. Would love to check with him if patients have a right to being seen at home ( I suspect they do...seems very unreasonable given your grandmothers history), however he has gone to bed. I will check with him at breakfast and try to get back to you before your grandmothers surgery opens.

GPs are not compelled to do home visis, some do more than others, some none at all , but the situation as it is with your GM home visits would seem appropriate.
Does she have district nursing at all? Many PTs now emply ommunuity matrons who could assess your GM and liase with the GPs if they are not willing to visit, otherwise she could move doctors to a pratie where the GPs are a bit more willing.

This sit may be a bit of help..

Ours don't do home visits without a lot of complaining! The emergency Gp at w/e and nights is particularly bad for it despite ther being 2/3 on at a time with a driver.
I would speak to practice manager and if they refuse to do home visits change Gps.I think the fact they gave meds without seeingher is disgraceful and TBH I would expect it not to be allowed.

My mil (who is in her late 70s and in fairly good health other than diabetes / panic attachs) has, on occasion, had home visits from her GP when she is laid low with something. It has always been the GP's suggestion and this is despite the fact that they live 5 minutes drive away from the surgery and fil could easily drive her there. I always thought this was a particularly good level of service the GP was giving.
I think the way your poor grandmother is being treated is particularly poor.

I don't know but maybe the meds were for a chronic condition, something she has been on for years but the pratice is being remiss in not keeping a check on things such as a blood pressure at least yearly.Most GPs are in the new contract which means no out of hours care is provided by them now.

Also meant to say that we have had home visits from the out of hours GP service ourselves recently (almost forgot about this). Once when dd (then aged 18 months) had a bad tummy bug in the middle of the night and once when dh was in agony and unable to move from a slipped disc.

I begegd for a doctor to come out to ds1 when he had a temp of just over 40, was shivering and vomiting at the age of 9 months. NHS told me no need to take him to A&E, but to call the out of hours GP. I did - he advised me to put my son in a taxi at 1am on a freezing cold night, with no car seat, and bring him to the GP centre 5 miles away. Disgraceful IMO.

same happened to me greensleeves, dd was three days old with a temperature and had to take her to the gp place at 4 o'clock at night. The day after I had to beg them to be seen by a paediatrician in hospital....

Lazy sods.

I can't see how the GP can refuse to do a house call. GPs are obliged in their contract to provide a basic level of care and in the case of somebody housebound this has to include house calls otherwise they shouldn't have housebound patients on their list. I'm a GP and have always done house calls in every practice I've worked in - I've never ever come across a practice with a no house call policy. If you don't get anywhere then write to the practice manager for an explanation.

HTH

I don't think they are lazy sods, while i totally see where you're coming from, if they visited evry person who rang during the night or at weekends they would harly be able to see anyone, and a medial centre is a more suitable place to examine people.
I have been in the same situation and denied a home visit when i felt it was necessary.

Last year I was invited to take part to a meeting discussing the local out of hours surgery and the impossibility of not getting house calls was the hot topic, and appeared to be very distressing, especially for older patients. I'm sure some gps of our surgery are still offering home visits though.

They never used to do house calls to everyone though, they used to do them for people who couldn't reasonably be expected to come out to see them - a young baby with a high temp and vomiting, in a family on the other side of town with no car/car seat, at 1am on a freezing cold night would pass most possible filtering criteria. If they wouldn't come out for that, they can't be doing many house calls. The doctor I spoke to actually considered coming out and decided not too - we could get a taxi instead.

Lazy sod.

With repect to the sick children out of hours - it is SO much easier to assess an ill child in a well lit health centre with all your equipment on hand plus in the time it takes to go on a house call you could be seeing half a dozen people in the health centre. Maybe not fair or nice if you're having to cart a sick child in a taxi but not really to do with laziness per se.

Hogwash. I don't believe for one moment that the reason for refusing to come out had anything to do with my son's welfare. As you'll know yourself, the level of examination required for a child with those symptoms before deciding between administering Calpol and puttnig back to bed/calling an ambulance is pretty basic. GPs don't do house calls any more because like everyone else these days, they are largely money-driven, resentful, obsessed with their rights and determined not to do a tap more than they absolutely have to.

Nobody could seriously suggest that a child is better served by being carted across town in a taxi with no car seat in the middle of the night than being briefly visited by a doctor at home.

Most modern homes are sufficiently well-lit and spacious to permit a basic medical examination.

pooka, i think in your grandmothers case (have read the following post, just the OP), she should be having home visits if she isnt mobile. As most of you know, Peter, my husband is in end stage heart failure. before his long admittance to hospital in 2005, he was seen regularly at home by our GP. It was usually on a once a week basis, as there was no way i could get him to the GP's (5mins walk away).

before we had a local out of hours centre, the GP would come out at night for sick children. We called them out several times for dd1, who had an awful lot of illness in her 1st year of life. they werre always good. GP has never been out for the other 2 though.

Oh dear.

I've been on both sides of the fence here as a doctor and a mum.

I love my job, don't resent it, don't resent being called out to anyone in genuine medical need. i don't think I'm lazy. and I've had to examine a lot of sick children in badly lit sitting rooms and worried that I might miss something important in the process.

And I'm knackered so off to bed!

Greensleeves, I can completely understand why you were so furious, I would have been aswell in the same situation.

Please, please don't lump all GP's into a lazy, greedy, rights obsessed box.

My DH regularly doen't get home until after 8pm. His last patient is booked in at 5pm. He regularly finishes his day by going out to see patients at home so that they won't have to use out the out of hours service. I KNOW he would never refuse to go out and see a poorly child at home if there was no transport available.

He spent most of today working for the local out of hours service and all he did was home visits.

Not all GP's are the same. Some really are lovely!!

I agree with Frayedknot, ask to speak to the practise manager. I know Dr's are very very busy people but surely if it's an elderly person living alone they should be given some sort of priority. Not every elderly person has family nearby to check in on them or take them to the dr's etc.

I think it's terrible that your grandmother hasn't been seen by a DR for over 2 years that can't possibly be right. Does she get some sort of elderly MOT, as my grandad used to call it, when a district nurse comes out to see her and check her over etc? My grandad got this every year from when he turned 80 until he died.

I had a similar situation with my granny on Easter weekend last year. She woke up one morning with a sore foot and it swelled so much she couldn't walk, couldn't put any pressure on her foot and couldn't put on any shoes. She phoned the emergency dr's because the surgeries were all closed for the holiday weekend and was told to take Paracetamol. The next day it was worse and phoned them again and was told the same, they refused, twice, to send anyone out to visit her, a 75 year old woman, living alone and unable to walk properly because of this problem. In the end on Easter monday she had to hobble to a taxi to take her to the emergency dr's where a nurse, not a dr, diagnosed a poisoned toe and gave her some antibiotics and sent her home.

She phoned her own dr when the surgery was open again on the Tuesday and again hobbled to a taxi to take her there where she was diagnosed with gout. there after followed various blood tests, changes of tablets that she's on and now she's ok.

but I was so cross, luckily for my granny we live downstairs and we were able to get her anything she needed like food and drinks and check that she was ok. But what if we didn't live so close by, what if we'd been away that weekend and she'd fallen and been badly hurt it doesn't bear thinking about. I really do think that elderly people should be given some sort of priority care in regards to home visits. Especially if they live alone.

If lighting is really such a problem that it makes house calls impractical, perhaps GPs should be issued with an emergency stash of daylight bulbs to take with them.

I don't wish to insult you personally, but your arguments are weak IMO. I've never yet heard a single good reason for GPs refusing to make house calls to sick children, and I've asked a fair few doctors.

I'm well aware that there are fantastic, dedicated, lovely GPs too, btw - my own GP (now, not then) is one of them. He called round on his day off to check I was OK when I had food poisoning while pg. He is marvellous with children. He is virtually a family friend actually - and we do have a couple of doctor friends. But they are not the ones defending this disgraceful insidious trend of GPs refusing to make house calls to people who really need them.