This document aims to outline a working process to facilitate efficient use of both GP and practice admin time, NHS funding and to provide good patient care. We may also help secure longer term funding if we can reduce hospital admissions.
Dr Sam Tapsell be providing visits every Thursday and Friday through February starting with full day visiting, 09.30 to 17.30. We will try starting with the MDT at Bideford Hospital, this page will be updated as the service evolves.
We have funding for 4 sessions, so these could evolve from 2 full days into a 4 days of half day service, with GP availability. We hope a 4 hour session 09.30 to 13.30 could be attractive for GPs with family commitments around school days.
Working from Home Base and SystmOne Access
My working base in Hartland is not central to Torridge Network. My home address is close to Northam surgery and the A39 so I will base from there. I will be using an NHS laptop securely connected to N3 via VPN and SystmOne, with smartcard. I have already been given smartcard access to all Torridge practices for shutdown cover, and I will contact practices if any issues with records access arise.
Home visit equipment and observations
I will visit with a Patient Summary, Stethoscope, Oxygen Saturations probe, BP cuff, Thermometer, Applewatch for 3 lead ECG, diagnostic set with otoscope and ophthalmoscope. I intend that most visits should include readings of Temperature, Pulse, BP, Saturations as basic recorded and coded observations which may be helpful to usual GP. I will also plan to carry emergency drugs, gloves, urine sample bottles.
I do not intend to collect any samples, but in the event that a patient needs non emergency blood collection, I would send a task to the usual GP. (I cannot generate ordecomm requests from my laptop, I am not sure if other GPs have this limitation with their laptops?). I may leave urine bottles with patients to request they forward to the surgery (eg if treating suspected UTI in patient aged >65).
I do not propose to use systmone via laptop “on the road”. My previous attempts in this regard have proven unreliable and frustrating.
Visit in clusters of 2-3 visits
Having a network GP driving back and forwards could involve large parts of the day spent in the car, with few visits delivered. I would propose trying to go do 2-3 visits in an area, before returning to base and writing up. This could allow up to 4 clusters of 3 visits with 12 patients seen in a day, making good use of the service.
Process of Booking home visit for the practice
- Patient requests a home visit, added to practice home visit list in SystmOne. Admin staff should ideally mention a GP visiting service, check would patient be happy to see a GP from the service and do they consent to this GP accessing their GP record?
- Admin staff confirm suitable for GP visit service with duty GP or usual GP
- Visit request sent by practice admin NHS mail to me at stapsell@nhs.net subject: visit request and minimum patient details of name, age and postcode along with reason for request. Please also attach a PDF (or word) comprehensive “home visit (problem based)” or similar to include recent consultations results, so that I can accept new visits by email “on the road”. To create the PDF click Save As, then select PDF. (the standard RTF format is difficult on a mobile phone for some reason). I am also happy to be contacted by SMS or WhatsApp on my mobile. (Not voice calls as I may be with a patient or driving).
- I will reply as soon as possible to practice admin email: visit accepted or visit declined (with reason, eg fully booked)
- After visiting, write up at base, prescribe if appropriate. Task “usual GP” to notify home visit done, highlight any issue, follow up or action. If I think a referral is needed, I will task the usual GP, perhaps with a draft referral outline. If the patient needs admission I will ring the hospital, hand write a referral letter, and ask the family to arrange transport by car or ambulance as appropriate.
Outstanding Questions
- Not sure how the practices feel about visits to care homes? Should they be included?
- Visits to verify death?
- Suggest children should be excluded from home visit service (most practices will have a policy of not providing home visits for children).
- Status updates. Do we want a brief daily update: number of patients seen, for which practices?
- Time of the service. Starting with 0930-1730 to allow for the 0930 MDT at Bideford hospital.
Share of Home Visits
If 24 visits is “full capacity” over 2 days, then indicative levels of home visits per week are as follows (based on headcount).
- Bideford 7.2
- Castle Gardens 3.2
- Hartland 1.3
- Northam 5.8
- Torrington 2.4
- Wooda 4.1
I suggest that after their “weekly allowance” is filled, I should aim to prioritise visits requested by other surgeries. This will be balanced alongside trying to make visits while “in the area” to balance the amount of time driving, rather seeing patients, to make best use of the service.
These numbers may not reflect the actual number of visits which can be properly delivered, and may need adjusting up or down.
Location Sharing
I will add a link to my live location here.
https://maps.app.goo.gl/ULYoou6Z7dpT4Ato9
New Home visit service daily email text.
Good morning,
there will be a home visit GP available today working 0930 to 1730. stapsell@nhs.net, Mob 07767 ******
About the service: Funded into June 2020, to try and reduce innappropriate acute admissions, free up GP time within practices, develop GP delivery of care in Torridge Network. Hope to develop into 4 days, 4h per day service in March as more doctors come on board a delivery rota. Will start each day attending MDT huddle at bideford hospital.
How to use, guide for practice staff:
- Patient requests home visit from their practice. They are asked if they would be OK to see a local GP, not from the practice, but who is covering the area for a home visit service? Would they be OK for this GP to use their medical records?
- Confirm visit suitable for visiting service with duty / usual GP.
- Send PDF (not RTF) summary, including recent consultations and test results, eg Systmone: Patient > Print > Print Summary > Home visit (problem based). Then Word: File > Save As > Save As Type > PDF. Email (attach) this summary to stapsell@nhs.net along with a “reason for visit request”. I will reply within 1h visit accepted or similar, or declined and reason.
- *NEW* Also remote book visit appointment via Appointments > Remote Booking > Hartland Surgery (Torridge Visits). This is the same process as Improved Access appointments, and will allow practices to judge home visit capacity when requesting a visit. Currently 7x 1hour slots (10am to 5pm). Where slots are full, it would still be OK to request by email as above, as I may still have capacity.
Please note I will not be monitoring the home visit bookings rota as I will be out and seeing patients, connected by mobile phone, not logging into SystmOne until I return to base to write up every 2-3 visits. (You must also email as above).
After a visit, I may wish to prescribe for a patient, eg antibiotics. I will send an “urgent task” to admin or prescriptions group at your practice to check this prescription has gone to the correct place. I will not log back into each practice to check for any task reply, so if you want to communicate, it will need to be by email (secure), SMS (not secure) or whatsApp (secure) message. I will state NO REPLY on these tasks.
If requested as above by task, can you please check any visit outcomes, such as a prescription, has been successful. This will help me carry on visiting, without worrying that the actions from earlier visits may not have been done, since I am mostly away from a computer while visiting.
Thanks