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GPs defend controversial motion to opt out of care home visits

The BMA is on track to lobby for a change in the upcoming GP contract after doctors passed a controversial motion over the weekend to opt out of home visits in light of excessive workforce pressures.

GPs at the BMA’s Special Conference of Local Medical Committees proposed a separate contract for patients in care homes, who are currently grouped with all other NHS patients.

The GP who proposed the motion to end care home visits, Dr Stefan Kuetter, claimed “you can’t say no for fear of being labelled uncaring or missing something” – adding that time spent in care homes is “disproportionately higher than time with other patients”.

Dr Chaand Nagpaul, chairman of the union’s GP committee, said because the current GP contract considers both groups of patients in the same way, “piecemeal” services end up “not doing justice” to care home users.

“This motion asks for the BMA to discuss with the government a separate contract for patients in care homes that reflects their additional needs, so that they can get the comprehensive care they deserve,” he said.

“This is not about GPs not looking after patients in care homes or withdrawing services: it is about them being able to provide focused care with the right resources and range of other staff to ensure that older patients with multiple medical needs get the service they deserve.”

In his keynote speech at the conference, Dr Nagpaul claimed nine in 10 GPs think workload pressures are damaging the quality of care they provide. But the system itself is also unsafe and unsustainable, he said, with GPs often having to see patients with complex multiple morbidity in just 10 minutes.

“It’s not safe for GPs to have up to 70 patient contacts daily conveyor belt style, and on top of that plough through hundreds of clinic letters, pathology results and reams of repeat prescriptions,” he argued.

“It's not safe for GPs to be examining patients while simultaneously having to take urgent calls from hospitals, district nurses and social workers, and also be called for an emergency home visit at the same time.

“To put it simply, it is not safe to carry on the way we are, and which is why this conference is highlighting that general practice is quite literally in a state of emergency.”

He also told the BBC Radio 4 Today programme that “you wouldn’t expect GPs for example to visit patients in hospital when they have been admitted to hospital”. He argued GP practices could continue to provide care, but under separate arrangements, and if they weren’t already overstretched.

But the motion, and their upcoming intention to lobby for a contract change when a new package is announced this month, was not well received by elderly people’s charities.

Caroline Abrahams, director of Age UK, told the Daily Mail that older people in care homes are “just as entitled as anyone else to good NHS treatment”.

“Because many are frail and unwell, continuity of care from a GP whom they get to know is especially important,” she said. “We would be very concerned at any move which hived off healthcare in care homes into a separate category and which led to more fragmented GP care for residents from an ever-changing cast of characters.”

A Department of Health spokesman added that GPs are contracted to “ensure their patients receive full and proper standards of care”, which necessarily includes carrying out home visits where needed.


Malcolm Daw   01/02/2016 at 14:33

GPs have a contract of care in the community which i may add is a very good one for a four and a half day week.Elderly in care homes are registered with the practice the same as they were when they lived at home.They are being singled out yet again as another route for GPs to seek extra monies on a separate contract.As a retired RGN who had 2 care homes know for a fact that care home patients are seen or visited far less by GPs than before they came in to care.By being in care homes the admission to hospitals are drastically reduced and therefore GPs paperwork and man hours are reduced for each of their patients in care.Those GPs that say they are overworked are usually the ones that receive massive fees for providing and volunteering to join their out of hours service.The contract at present given to GPs are very generous and they know it but they are never happy with their lot but are happy to work at night and weekends for lucrative funds.Bring back GP 24 hour responsibility for care and reduce the AandE waiting times and far less seen in hospitals overall.

Jamie   02/02/2016 at 16:18

Malcolm. As a retired RGN you will of course know of the current crisis in general practice. GPs feel overwhelmed and are leaving in droves. PRactices cannot recruit enough GPs to keep up with demand, putting strain ont he few who remain. The income of practice partners has been falling year on year for a number of years now. Would you agree you do not tend to get such recruitment problems in a happy well paid workforce do you? Would you agree that if there are already problems then adding extra responsibilities and removing pay will likely make things worse rather than better.

Agnes   02/02/2016 at 17:24

As a GP whose practice cared for patients in a care home which specialised in taking rapid discharges from hospitals for patients nearing the end of life I can say that this work is not only onerous although clinically satisfying it was often done for free as average length of stay in home was 2weeks before death and capitation payments require patients to be registered with practice past a quarter date. 25 years ago it was not unusual for patients in nursing or residential homes to go on holiday or even still drive, today these patients are very frail, have multiple morbidities and are sadly short changed by present system.

Dom   03/02/2016 at 15:57

I think that it costs more than £2 to provide medical care for this complex group of patients. So if that is all the NHS is prepared to pay GPs then it should come as no surprise whatsoever to anyone who has a mortgage to pay that GPs want to quit this work. I am not sure how Malcolm sees £2 a week as being "massive fees" "lucrative" or "very generous". One must assume that he has very low outgoings.

Lars   05/02/2016 at 18:01

The GP profession is in demand and there are less appointments in a surgery due to availability of GPs. I am working with senior GP they are full of knowledge. My be it is at the time the goverment makes use of physician assistant and paramedic practitioners and opens prescribing for them. MDT approach is the future and more time can be allocated to AHPs. Also case reviews with GP, AHP, Nurse, pharmacist are good for patient and relatives. I only fear that junior GPs are losing a skill to manage senior citizen problems as they have less exposure.

Mary   07/02/2016 at 21:50

Well withdrawal of services in care homes will put increasing demands on A&E and urgent centres having to cope with patients who should not be there. Let's hope it is not one of our own family. Yes, another option would be for care homes to be covered by a separate contact. However, that would mean the GP cover would only be staffed by agency docs.that is how the urgent care service is staffed at a lucrative cost but great financial benefit for the doc covering the shift . Actually, this must be another reason not wanting to participate in a 24/7 service as could do a shift on a weekend shift as the rates are even more higher. Why on earth would doctors be tired after there 9 sessions a week paying somtimes more than a MP, in addition to 12 hour shifts in urgent care ? Covering a care home under a different contract, surely this would be far to much? How about GPs having to declare their real income submitted to their tax accountant? Should we not ask these publically paid staff to declare their income like the freedom of infornation regulated public figures?

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