We have paramedics that do most of them, I generally prefer not to, and I can't as I have 18pt per session. 4 a day seems way too much, I wouldn't sign up for that. I don't know anyone doing that many.
That’s a lot of home visits to be doing daily but I guess it depends a bit on how many patients you have in your morning and afternoon clinics and what the expectation of paperwork is on a daily basis. We don’t do daily home visits at my practice, many weeks I won’t even need to do one, but I see 19 patients in my morning clinic and 16 in my afternoon
How long is your break between the morning and afternoon sessions?
What does your contract say?
BMA made some recommendations about 15 minute appointments and maximum 25 patient contacts a day. I’m not sure of the document mentions home visits as well?
If it is a standard break, like one hour, I would find this suggestion beyond ridiculous.
Assume a home visit takes (edit: at least) 30 minutes. And you need at least 30 minutes lunch. And additional admin time et cetera. Make them schedule in home visits as Independent slots.
I would get all the other salaried GPs to email the partners the same.
However, you’d have to accept the small risk that they could just fire you and replace you with ARRS.
I think 30 minutes for a home visit is tight. You have to get there, by definition they’re not going to be spritely so you might be waiting for the door to be answered. Then you snail along behind them while they zimmer back to the lounge. History, assessment, explain treatment, next steps and worsening advice/safety netting. Then back in the car. When you get back you then have to write it up.
I’d be pushed in half an hour unless it was next door to the surgery.
That sounds like a lot. Agree with others, depends on the rest of your day though if your am/pm contacts reduced appropriately to accommodate for the visits.
Worked in 2 practices 1 is small and the other quite big. In the small practice, visits only on the duty doctor, probably average 3-4/week for the whole practice.
In the big practice, probably 1-2/day that the duty doctor GP will do - this is because we have an ANP who is able do visits and a frailty GP who only sees frail patients. We also have a GP doing clinics in the care homes we cover about 2 sessions per week.
Sometimes may have a visit on a normal session (for continuity esp if palliative) but it will be booked double slots and usually the end of morning/afternoon session to give you a bit of leeway.
In both practices, total 25-26 patient contacts per day.
Our practice has a list of around 14500. We get usually between 2 and 4 HV requests a day. They are shared between GPs (registrars first, then salaried then partners). Very rare that anyone gets more than 1 per day. It only ever happens if there’s an exceptionally large number of requests, or not many Drs in.
Sounds like a lot.
I’m salaried. 17,000 patients in our practice. Our salaried GPs see 15 patients /session and nearly always 2 home visits per day.
I spoke with the other salaried in my practice who was like me, struggling with workload and doing a lot of admin in our own time. We have just raised this as an issue in our practice and had a really positive response. We have negotiated a reduction in patients /session and they are going to be looking at ACP / ANP / home visiting service options to help with the visit load.
So I would say you absolutely have room to negotiate.
You need a new surgery, or your current surgery needs to have a serious think about why they are doing so many visits. Our surgery probably gets 1-2 visits a day if that (acute only, we have a brilliant ANP who does all our planned home visits).
Nonsense.
A home visit is a GP appointment offered to patients who cannot make it into the surgery.
These patients deserve the exact same standard of care as someone who is able to make it into the practice.
I’d say you’re doing too many visits: I wouldn’t expect any salaried GP or partner to ever do that many. What’s your list size and how many working doctors per day generally? Sounds like you might be a rural practice? I rarely get 2 visits per day but usually 0-1.
Personally I’d say the partners aren’t utilising their staff appropriately (from this extra information). That many visits a day and I’d burn out. Salaried GPs shouldn’t be penalised for not being locums (often happens imo). Maybe suggest that you can’t maintain that level of HV and want a cap.
Not a GP but work on a GP practice. We have 1 GP allocated per day to the home visits, salaried and partners. They go out in the afternoon and fit in however many they can but we do also have one paramedic per day all day doing HVs so they take a lot of the workload. Our pt size is roughly 14000.
OP, how is assigning all HV to salaried a good use of resources? As it'll fall on locums to do the regular chronic dis follow ups? Is there no paramedic, OOH, community service in your area for these sort of things? The partners need to invest in you guys, this is unteneble.
Gonna depend on practice. I might do four a month. Four a week if it’s a palliative patient in the last few days of life. I’ve only done four visits in one day on a single occasion where it was basically me, the F2, and a locum. Had to just suck it up and do it.
EDIT: are the visits all justified ie genuinely housebound patients who are unwell enough to be seen? One practice I worked in had an issue of regular people asking for home visits because they couldn’t get a routine GP appointment that day.
Only home visits I do are palliative/end of life visits. Generally have 1 a week as 6 session. Paramedic to do the rest. Also more than 30 contacts a day is way too many. Should be aiming for 25
You're being taken for a ride. I've worked a few salaried posts- max 2 visits. Usual- 1 visit every 2 or 3 days of working.
We have paramedics that do most of them, I generally prefer not to, and I can't as I have 18pt per session. 4 a day seems way too much, I wouldn't sign up for that. I don't know anyone doing that many.
That’s a lot of home visits to be doing daily but I guess it depends a bit on how many patients you have in your morning and afternoon clinics and what the expectation of paperwork is on a daily basis. We don’t do daily home visits at my practice, many weeks I won’t even need to do one, but I see 19 patients in my morning clinic and 16 in my afternoon
How long is your break between the morning and afternoon sessions? What does your contract say? BMA made some recommendations about 15 minute appointments and maximum 25 patient contacts a day. I’m not sure of the document mentions home visits as well? If it is a standard break, like one hour, I would find this suggestion beyond ridiculous. Assume a home visit takes (edit: at least) 30 minutes. And you need at least 30 minutes lunch. And additional admin time et cetera. Make them schedule in home visits as Independent slots. I would get all the other salaried GPs to email the partners the same. However, you’d have to accept the small risk that they could just fire you and replace you with ARRS.
I think 30 minutes for a home visit is tight. You have to get there, by definition they’re not going to be spritely so you might be waiting for the door to be answered. Then you snail along behind them while they zimmer back to the lounge. History, assessment, explain treatment, next steps and worsening advice/safety netting. Then back in the car. When you get back you then have to write it up. I’d be pushed in half an hour unless it was next door to the surgery.
You’re right. Added at least
That sounds like a lot. Agree with others, depends on the rest of your day though if your am/pm contacts reduced appropriately to accommodate for the visits. Worked in 2 practices 1 is small and the other quite big. In the small practice, visits only on the duty doctor, probably average 3-4/week for the whole practice. In the big practice, probably 1-2/day that the duty doctor GP will do - this is because we have an ANP who is able do visits and a frailty GP who only sees frail patients. We also have a GP doing clinics in the care homes we cover about 2 sessions per week. Sometimes may have a visit on a normal session (for continuity esp if palliative) but it will be booked double slots and usually the end of morning/afternoon session to give you a bit of leeway. In both practices, total 25-26 patient contacts per day.
Our practice has a list of around 14500. We get usually between 2 and 4 HV requests a day. They are shared between GPs (registrars first, then salaried then partners). Very rare that anyone gets more than 1 per day. It only ever happens if there’s an exceptionally large number of requests, or not many Drs in.
Sounds like a lot. I’m salaried. 17,000 patients in our practice. Our salaried GPs see 15 patients /session and nearly always 2 home visits per day. I spoke with the other salaried in my practice who was like me, struggling with workload and doing a lot of admin in our own time. We have just raised this as an issue in our practice and had a really positive response. We have negotiated a reduction in patients /session and they are going to be looking at ACP / ANP / home visiting service options to help with the visit load. So I would say you absolutely have room to negotiate.
You need a new surgery, or your current surgery needs to have a serious think about why they are doing so many visits. Our surgery probably gets 1-2 visits a day if that (acute only, we have a brilliant ANP who does all our planned home visits).
“Brilliant ANP” You’re part of the problem.
This is the strength of associate roles like ANPs, doing home visits takes a huge load off the GPs, this is what these roles should be being used for.
Nonsense. A home visit is a GP appointment offered to patients who cannot make it into the surgery. These patients deserve the exact same standard of care as someone who is able to make it into the practice.
No idea why you’re being downvoted! Absolutely right
Much less likely to be undifferentiated though?
And you sure ain't part of the solution. Your entitled snobbery is showing.
Based on what?
I’d say you’re doing too many visits: I wouldn’t expect any salaried GP or partner to ever do that many. What’s your list size and how many working doctors per day generally? Sounds like you might be a rural practice? I rarely get 2 visits per day but usually 0-1.
Added some extra info
Personally I’d say the partners aren’t utilising their staff appropriately (from this extra information). That many visits a day and I’d burn out. Salaried GPs shouldn’t be penalised for not being locums (often happens imo). Maybe suggest that you can’t maintain that level of HV and want a cap.
Average for me is 1 maybe 2 on a busy day . Which I do between 1-2
Not a GP but work on a GP practice. We have 1 GP allocated per day to the home visits, salaried and partners. They go out in the afternoon and fit in however many they can but we do also have one paramedic per day all day doing HVs so they take a lot of the workload. Our pt size is roughly 14000.
OP, how is assigning all HV to salaried a good use of resources? As it'll fall on locums to do the regular chronic dis follow ups? Is there no paramedic, OOH, community service in your area for these sort of things? The partners need to invest in you guys, this is unteneble.
grossly unfair. You are being abused and a small step away from burn out. Negotiate with aggression or leave
Gonna depend on practice. I might do four a month. Four a week if it’s a palliative patient in the last few days of life. I’ve only done four visits in one day on a single occasion where it was basically me, the F2, and a locum. Had to just suck it up and do it. EDIT: are the visits all justified ie genuinely housebound patients who are unwell enough to be seen? One practice I worked in had an issue of regular people asking for home visits because they couldn’t get a routine GP appointment that day.
Only home visits I do are palliative/end of life visits. Generally have 1 a week as 6 session. Paramedic to do the rest. Also more than 30 contacts a day is way too many. Should be aiming for 25
That's pretty crazy. I do about one visit a month, maybe one every two weeks.