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Commissioners may implement enhanced service for urgent home visits under NHS plans

Commissioners may implement enhanced service for urgent home visits under NHS plans

Commissioners are considering local enhanced services for GPs to do more urgent home visits next year under new NHS England plans to reduce A&E pressures
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Commissioners are considering local enhanced services for GPs to do more urgent home visits next year under new NHS England plans to reduce A&E pressures.

NHS England has asked CCGs to work with NHS 111 providers and councils to set up A&E Delivery Boards to consider this model alongside measures such as more GPs in A&E departments.

The boards will be responsible for drawing up plans to avert winter pressures, but NHS England has also sent out “best practice” guidance for year-round measures to reduce pressure on A&E, due to be implemented by June next year.

As part of the plan, NHS England has advised the boards to “have processes in place to respond to and prioritise requests for urgent home visits, usually through early telephone assessment and a duty doctor rota”.

The guidance said: “Early and effective assessment of frail and vulnerable adults can enable general practice to plan alternatives to hospital admissions or arrange for early specialist hospital review.

“Where specialist assessment is needed, early conveyance ensures that patients attend hospital early enough to avoid a default admission, which is typical where patients arrive after 2pm.”

Asked how this may be delivered on the ground, an NHS England spokesperson said LESs are one way but that it was “for local systems to determine the best solution for implementation”.

NHS Luton CCG included the “national expectations” of CCGs following the A&E Improvement Plan in its own plans to deal with winter pressures.

While it includes the target of incentivising GP home visits through a LES, a spokesperson said it does not apply to Luton because the area already has a Rapid Crisis Response Team in place.

They added: “The listed milestones in the Winter plan are those interventions and suggestions made by NHS England. Each A&E Delivery Board must review those interventions and suggested milestones to assess whether they are relevant for their own local health and social care economy.”

GPC deputy chair Dr Richard Vautrey said these initiatives are being pushed because of increased demand on the NHS all year round.

He said: “Many CCGs, and PCTs before them, have developed schemes focused on winter pressures. The reality now is that the health and social care system is under severe pressure 12 months of the year, and needs additional support throughout the year.

“It's important that all such schemes are properly resourced and don't just have a narrow focus on A&E activity and hospital admission but also recognise the significant pressure that general practices are under as well.”

He added that incentivising GP home visits should “be negotiated with LMCs who would know what was workable for their particular area”.

But Dr Peter Swinyard, chair of the Family Doctor Association, said incentivising GPs to carry out urgent home visits is “trying to put a sticking plaster” on increasing ambulance delays, and GPs no longer have “the resources to go rushing off in the middle of surgery”.

He said: “If you’re working in the surgery during the day, you are absolutely chock-a-block and you don’t have time to rush out and do an emergency home visit. If you do that you have four patients sitting in the waiting room who are not going to be seen.

“I think the Government is trying to put a sticking plaster on the fact that the ambulance services are not responding in a timely fashion and they are trying to dump the problem on to general practice.”

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