Home Visiting Policy
Introduction
General Practices and i-Heart365 are expected to undertake home visits as part of patient care. The purpose of this of this document is to determine the process for General Practice.
Home visit request timing
· Requests for home visits must be received in a morning, in order for them to be triaged as early as possible and carried out after morning surgery. Visits for the housebound will usually be made the same day when they are requested before the end of morning surgery.
· Non-urgent/routine visit requests received for the housebound will be triaged and carried out within a timescale that is assessed to be safe based on the information received.
Call handling
The Patient or caller requesting a home visit will be asked by the call handler who is trained to deal with home visit requests to describe their symptoms and confirm their address and contact details, how to gain access etc. All information will remain confidential.
The Patient will be advised by the call handler to expect a telephone call from a clinician before the visit and the purpose of the call (triage).
Clinicians will review visit requests and usually telephone the patient before, or instead of, visiting as telephone triage may indicate that a visit is not necessary.
When a home visit is triaged and assessed as not required, the clinician will make an appropriate, alternative plan for the Patient for the intervention indicated e.g. a face-to-face appointment, referral to another service or a follow-up telephone consultation.
Rejected Home Visits
For the instances where i-Heart365 Services are not used for home visits, the following should be considered:
· GPs will not automatically visit any Patient who requests a home visit.
· Patients cannot insist on a home visit.
· Every home visit will be triaged by a qualified clinician to decide whether the Patient's medical condition requires a home visit and, if so, how quickly.
· GPs are not obliged to visit a Patient if they have assessed the Patient's clinical need and decided that the Patient is suitable for an alternative method of healthcare, e.g. a face to face or telephone appointment with a healthcare professional.
· GPs will not normally provide routine home visits unless the Patient is terminally ill or housebound, making travelling by car cause deterioration to their medical condition or unacceptable discomfort.
Clinicians will make an appropriate, alternative plan for Patients for whom a home visit has been declined on the grounds that it is not clinically necessary and based on the assessment made by a clinician of the information received.
This may be a same day appointment or another day, a telephone consultation or advice to attend A&E or a minor injuries unit, or a message communicated to the Patient by a staff member on behalf of the clinician.
Emergency/999
Staff will be trained to manage all requests safely and consistently for a home visit and will be trained to deal with calls received about emergency patient symptoms and situations when they need to call 999 for an emergency ambulance or advise the caller to do so for:
· Chest pain;
· Shortness of breath;
· Severe bleeding;
· Suspected stroke;
· Loss of consciousness/collapse;
· Unresponsive state.
Children
Clinicians will visit children at home only when clinically indicated. BHF expects a responsible adult to be available to bring a child to the surgery where they will be seen as soon as possible or clinically indicated as triaged by a clinician.
Where a home visit is requested for a child, the responsible adult for the sick child will normally be asked to bring the child to practice, where they will be seen as quickly as possible or according to the symptoms reported.
In situations where the call handler detects an urgent concern about a child's health, the visit request (call) will be passed to a GP immediately or the GP will call back straight away.
If a parent refuses to attend the practice (or the out of hours centre) when the reported symptoms do not indicate the necessity for a home visit, the health of the child will take precedence over other issues and, as a result, a visit may become necessary.
The parent may be advised of inappropriate action or behaviour on their part separately at a later date.
Out of Area
BHF is under no obligation to visit patients with 'Out of Area' scheme registration as arrangements will be available for them to be seen near to their home.
Professionals providing this service should be aware of the following:
· Agreed criteria for Patients who need and will receive a home visit.
· Have a safe and appropriately responsive triage system in place to prioritise home visits requested on the day that are not routine visits to housebound and care home Patients.
· Children can be brought to Clinic by a responsible adult and generally do not need to be visited at home. If an adult insists that a child be visited or cannot be brought to Clinic, the child's health will be treated as the absolute priority. Any inappropriate behaviour on the part of the adult concerned will be addressed separately at a later date.
· Practices will need to make reasonable adjustments for Patients and people with learning and physical disabilities so that they can access services without being disadvantaged.
· Patients for whom a visit request is declined will be offered appropriate, alternative arrangements that may range from a telephone or face-to-face consultation that day or another time, to a referral on to another service or, when serious symptoms or circumstances are the reason for requesting an urgent visit, a 999 ambulance.
· BHF Practices are under no obligation to visit Patients with 'Out of Area' scheme registration - https://www.england.nhs.uk/publication/choice-of-gp-practice-guidance-on-the-new-out-of-area-patient-registration-arrangements/
· BHF Practices will maintain a list of housebound Patients to ensure a consistent approach by all members of the team in respect of triaging and carrying out home visits.
· BHF Practices are not an emergency response service and call handling staff members will work to a protocol of calling 999 for an emergency ambulance when a caller describes serious symptoms that indicate urgent, life-saving medical assistance is necessary without delay.
People affected by this service should be aware of the following:
· BHF will publicise the criteria for assessing requests for a home visit in the surgery, on the website and in any other suitable places where has a media presence.
· BHF Practices will always prioritise a home visit request by assessing your individual health needs in relation to those of the other Patients registered. This is to make sure that available clinical resources are allocated fairly for the safety and quality of care of the whole Patient population registered.
· You are responsible for getting to Clinic unless you are housebound. BHF Practices are not responsible for transporting you to the surgery in adverse weather conditions, if you do not have a car, do not have money for transport or you say you are unable to make the journey.
· BHF Practices will work with you if you have a physical and/or psychological disability to ensure that you can communicate with us and receive the appropriate care that meets your needs in the most effective environment according to a care plan that will remain under regular review.
· BHF Practices are not an emergency service and cannot respond sufficiently quickly when you are at home. If you have a medical emergency, you must call 999 for an emergency ambulance.