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How to Make Sure Home Visit Prioritisation is Effective

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A few weeks ago, NHS England felt it necessary to issue a Patient Safety Alert with regards to home visits by GPs. The alert was prompted by the death of a patient who had requested a home visit but died before the GP was able to attend the patient’s home.

The GP rostered to conduct home visits was unaware of the patient’s recent discharge from hospital and the severity of the patient’s rapidly deteriorating condition. Consequently, the visit was diarised at the end of the day. However, before the GP could get there, the patient had to be taken to hospital and subsequently died there.

Lessons to be learned

Clearly, if the GP had been informed of the full extent of the patient’s ill health things may have turned out differently. Unfortunately, the incident described above is not alone: when the National Reporting and Learning System was searched, 11 incidents that resulted in either severe harm or death and related to home visits during the last two-years were found.

At the heart of these incidents lies poor decision making processes within the GP practice with regards to home visits. The outcome is that the practice must have in place processes and procedures that are able to assess the level of need and:

- If a home visit is clinically necessary; and

- The urgency of the need for medical attention.

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Relevance to CQC inspections

The need for such processes and procedures is recognised by the CQC when it inspects GP practices. Its Key Lines of Enquiry (KLOEs) include assessment of responsiveness to patient needs and the provision of safe care. In fact, the CQC inspector will specifically look for evidence that shows the practice makes home visits available to patients who need them, and that processes are in place ensure that:

- A home visit is necessary

- Home visits are prioritised effectively

- Appropriate action is taken if a the need is more urgent or a GP home visit is deemed to be inappropriate

What every GP practice should do immediately

The failing of assessment of home visit lies in two areas:

The first of these is in the process itself. As the patient safety alert highlights, an easy process could be put in place that ensures:

The practice telephones “the patient or carer in advance to gather information to allow for an informed decision to be made on prioritisation according to clinical need. In some cases the urgency of need will be so great that it will be inappropriate for the patient to wait for a GP home visit and alternative emergency care arrangements will be necessary.”

The second area of concern is in the review of process and adequate process training. In this regard, the patient safety alert states:

"Many practices will already have systems in place to manage home visits. Where this is the case, consideration should be given to whether a review is required in light of this alert. The review should also consider whether all clinical and non-clinical staff involved in the process are aware of their responsibilities when managing requests for home visits, and if any outstanding training needs exist.”

The conclusion that can be drawn from the issue of the safety alert, and the patient outcome that led to it, is that the CQC are likely to place greater emphasis on this area of their inspection. GP practices have been warned!

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