When I was a young doctor, I used to stop in every Tuesday morning at the home of a patient in her 80s, a chain-smoker who was bedridden with emphysema.
There was little medical that could be done for her. She would sit up in bed, a cheroot in one hand and oxygen mask in the other — it was a wonder we didn’t get blown up — and regale me with stories of how she and a girlfriend drove around India in a Rolls-Royce in the Thirties.
Then she’d pick up the Racing Post and instruct me to put her bets on the afternoon races.
This week, the doctors’ trade union GPC England will vote on lobbying the NHS to end home visits (file image)
That kind of friendship between a GP and his patients has all but died out today. This week, the doctors’ trade union GPC England will vote on lobbying the NHS to end home visits. They say GPs no longer have the ‘capacity’ to carry them out and describe them as ‘an anachronism’.
The doctor putting forward the motion, Dr Andy Parkin from Kent, claims that home visits place an unnecessary strain on workload and adds: ‘I don’t tend to do home visits as they’re not part of my terms and conditions.’
It is true home visits have become increasingly infrequent over the years, but Dr Parkin’s comment appals me. It amounts to nothing less than a death knell for medicine as a true vocation.
Home visits were a major cause in shaping my ambition to be a GP in the early Seventies. They were rewarding and thoroughly enjoyable, giving me a rich sense of purpose in my work. And now they seem certain to disappear.
Without home visits, many patients — such as the eccentric old girl with the Racing Post — simply will not ever see a GP. Their quality of life will suffer seriously as a result, and a greater strain will be placed on their families. Equally important, doctors will lose one of their most valuable sources of information, a real insight into their patients’ lives.
I first began to understand the value of this as a medical trainee at a GP’s practice in Barnes, South-West London, under the tutelage of an energetic, bearded fellow named Dr James Scobie, who went everywhere by bicycle.
Going out with him every lunchtime to do a house call or two, and sometimes adding one at the end of the afternoon, I realised for the first time that general practice was what I wanted to do with my life.
One stop might require care for the dying, the next a check-up for concussion in a child who fell off a swing onto concrete in a play park. I quickly learned that being a GP was less about diseases than about being an expert on people.
A doctor on call learns so much about the circumstances of different families. It’s often the only way to spot whether a husband is knocking his wife about or a mother is a secret drunk.
You can tell as much from a house that is obsessively, neurotically tidy as you can from one that is piled high with a hoarder’s rubbish.
As I gained experience, I felt more confident making home visits.
Home visits were a major cause in shaping my ambition to be a GP in the early Seventies (file image)
This became noticeable on occasions when I was joined by a consultant, for what were known as ‘domiciliary visits’. Though I was much more junior than the specialist, I was also more at ease: the senior man didn’t know whether to sit or stand, whether or not to accept a cup of tea, whereas I felt instinctively comfortable throwing my coat over the bannister post and getting down to business.
Of course home visits are more time-consuming than the conveyor belt of surgery consultations, each lasting no more than eight or ten minutes. Part of the problem is the increased pressure on GPs’ practices, contending with an ageing population and ever-growing towns.
But another factor is how many commitments doctors have outside work. Now that more than half of GPs are women, many juggling families with work, the days when a doctor could be on call at any moment are over.
It horrifies me that ‘terms and conditions’ should be cited as a reason to curtail home visits.
It sometimes seems that too many GPs now are chiefly concerned with their salaries, pensions and holiday packages — to me, the rot set in back in 2004 when the doctors’ union negotiated a new contract with the Labour government, whereby they were paid substantially more for doing significantly less.
But whatever the cause, the emphasis today is on a ‘work-life balance’ — regardless of the fact that a GP’s work is surely all about other people’s lives.
I remember returning home one wet Sunday evening after a family trip, to a message from two patients asking me to come out to their home: their au pair, a teenage Italian girl, was sick in bed with flu.
I listened to the symptoms, gave them some advice on keeping her well hydrated, and promised to visit in the morning on my way to work.
Thank goodness I did. When I examined the patient, she had purple marks like tea leaves on her wrists. I recognised the symptoms of meningococcal meningitis immediately, which untreated can be fatal in up to half of cases, often within a few hours. If I had told that couple to bring their au pair to the surgery, she might easily have died before receiving treatment.
So impossible is it to get a GP appointment these days that the only recourse for people with everyday illnesses such as heavy colds is to visit their nearest Accident and Emergency department.
This has become so normalised that I noticed on The Archers recently that parents of a baby suffering from flu talked about taking her to the Casualty ward as the natural thing to do.
The result is that hospitals are overrun with patients who would be much better seen in their own homes by their GPs. This crisis also affects the emergency services. It has become common for lonely sufferers from dementia to dial 999 and ask for an ambulance, just to get some attention.
The cost to the NHS is huge, but the consequences can be even worse if paramedics are delayed in getting to a serious incident, such as a road accident, because they had been called out for the umpteenth time by a confused, elderly patient.
Dr Scobie had a marvellous way for calming such patients. He would leave a note on their telephone, in bold, clear pencil, which said: ‘The doctor is coming tomorrow.’
This simple ruse offered reassurance — and of course the doctor would make sure he pedalled over at least twice a week.
Now that house calls are to become a thing of the past, that care will be lost. The result is more time-wasting call-outs for ambulance crews, and more uncertainty and loneliness for patients.
People like me became general practitioners for love of the job.
The end of house calls spells the end of those days.
Source: Martin Scurr