Home Visit Policy

1       Introduction

1.1      Policy statement

The purpose of this document is to ensure that all personnel fully understand the practice system for the triaging and prioritising of home visits, thereby ensuring that patient safety is not compromised.

1.2      Status

This document and any procedures contained within it are non-contractual and may be modified or withdrawn at any time. For the avoidance of doubt, it does not form part of your contract of employment.

1.3      Training and support

The practice will provide guidance and support to help those to whom it applies understand their rights and responsibilities under this policy. Additional support will be provided to managers and supervisors to enable them to deal more effectively with matters arising from this policy.

2       Scope

2.1      Who it applies to

This document applies to all employees of the practice and other individuals performing functions in relation to the practice, such as agency workers, locums and contractors.

2.2      Why and how it applies to them

Following a patient safety alert issued by NHS England in April 2016[1], it was recognised that there is a requirement for practices to have in place a system to triage and prioritise home visits. The alert states:

“When a request for a home visit is made, it is vital that practices have a system in place to assess:

  • whether a home visit is clinically necessary; and
  • the urgency of the need for medical attention.”

The practice aims to design and implement policies and procedures that meet the diverse needs of our service and workforce, ensuring that none are placed at a disadvantage compared with others, in accordance with the Equality Act 2010.  Consideration has been given to the impact this policy might have in regard to the individual protected characteristics of those to whom it applies.

3       Policy

3.1      Home visit requests

Requests for home visits at Headstone Road Surgery are received via telephone between [0800 and 1100]. Requests received after [1100] are to be referred to the duty doctor.

All requests for home visits are triaged by GP, ECP, ANP and recorded on emis. When discussing with the patient their condition, it is essential that the following are confirmed:

  • Patient’s full name (if not the patient, full name of the person calling and relationship to patient)
  • Date of birth
  • Address
  • Contact telephone number
  • Named GP
  • Known existing medical conditions
  • Reason for calling/duration of symptoms

3.2      Home visit justification

Home visits are at the discretion of the GP who will determine if the visit is clinically necessary. Visits are reserved for patients who are genuinely housebound, including those in nursing and residential homes, and terminally ill patients.

A GP or ANP may conduct a home visit if they believe the patient’s condition:

  1. Prevents them from travelling to the practice, or
  2. The condition may deteriorate as a result of travelling to the practice

Home visits will not be authorised as a result of:

  1. A lack of transport
  2. The patient’s financial situation
  3. Childcare issues
  4. Poor weather conditions
  5. Any other situation deemed inappropriate by the clinician

3.3      Home visit management system

At Headstone Road Surgery, the flow diagram at Annex A illustrates the processes which are to be adhered to for home visit requests.

3.4      Recording information

The Quality Outcomes Framework (QOF) is a means of ‘rewarding practices for the provision of quality care’. There are 559 available points for the QOF across two domains; the value per QOF point is £165.18. It is therefore appropriate to ensure that during home visits, information is recorded which can subsequently be coded and inputted onto emis. The form at Annex B is to be used to record such information.

3.5      ANPs and home visits

At Headstone Road Surgery, ANPs are permitted to undertake home visits for patients with chronic diseases and undiagnosed conditions. The home visit management system (Annex A) is used at the practice to make certain patients receive a home visit in a timely manner.

ANPs who are willing and contracted to undertake home visits will follow the ANP home visit process as detailed overleaf.

Home visit consultations are to be structured just as if the consultation had taken place in the practice. The preferred format for home visit consultations is illustrated overleaf.

Complains Of (C/O) The reason the patient has requested the home visit
History (Hx) Onset, exacerbating or relieving factors
Past Medical History (PMHx) Record any other medical conditions the patient has
Family History (FHx) If relevant, gather information about the patient’s family history
Social History (SHx) Consider patient background, if they are a carer or have carers. Include smoking and alcohol status, consider mood, mobility, nutrition, etc.
Drug History (DHx) Record current medication
On Examination (O/E) Conduct an assessment of the patient which must include BP, PR, RR, Temp
Diagnosis (Δ)

 

Document initial diagnosis
Treatment (Tx)

 

Document treatment provided during visit
Prescription (Rx) State (if applicable) what medicines have been prescribed, detailing dosage and frequency
Plan Explain (and document) plan, to include follow-up, advise given, etc.

 

The ANP must ensure that the notes made during the home visit are entered on the clinical system in the individual’s healthcare record as soon as they return to the practice.

4       Summary

Home visits are a fundamental element of general practice and they enable the practice to meet the needs of the patient and ensure that care and treatment are provided in a timely manner. To make sure that the care delivered outside the confines of the practice is appropriate and effective, visits must be structured and clinicians must follow the guidance provided. By doing so, patients will receive the necessary level of care in an appropriate time frame.

[1] NHS/PSA/W/2016/002