01.02.16
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.