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Threats to NHS patients at home and away

RUTH HUNT sounds the alarm over Tory plans that will cut GP visits to those that need them most

JEREMY CORBYN has alerted us to the existential threats to the NHS coming from initial trade talks with the US.

Closer to home, however, there’s also the constant reminder of the pressure the NHS is under.

For example, the measures which have emerged from secret talks to limit certain tests and operations to patients, and a motion passed by GPs regarding house calls.

Both signify limiting access to NHS services, but it is the house calls motion which is causing the most concern to vulnerable patients.

This came from a proposal on November 22 to stop home visits being part of GPs’ contracts, due to the immense pressure GPs are under.

This would ultimately impact those patients who are the most in need.

These same patients have already been targeted again and again both directly and indirectly by Tory cruelty towards those they think have no voice.

The chair of the British Medical Association’s GP committee Dr Vautrey said: “GPs are telling us that it would be much better if there was a dedicated home visiting team.

“Practices could focus on the needs of patients in the surgery while a specialist team of people made up of nurses, paramedics and GPs visited those who are housebound.”

This has faced resistance from the Royal College of GPs (RCGP).

RCGP chair Professor Martin Marshall said that home visits were a core part of general practice when used wisely.

Why should those patients who are housebound due to disability or age receive a second-rate service from their GP surgery?

Is a nurse or paramedic comparable with a GP who has, in most cases, spent years getting to know the patient?

This point was raised by Marshall, who said: “We are very supportive of proposals to train other members of the GP team such as physician associates and advanced paramedics to carry out home visits as appropriate — but they are not a substitute for GPs.”

It is bad enough that this cohort of patients have often suffered the most due to cuts in service provision and benefits without the only consistent lifeline, their GP, being replaced by a “home visiting team.”

Home visiting team members would need to work in a shift pattern, meaning continuity of care would be lost, something that is vital when dealing with patients with multiple and complex needs.

If these changes do come to fruition, it would appear to be an ideal case to be legally challenged on the grounds of discrimination as those who are able-bodied would be getting a different standard of service from those who are not.

There is a parallel here in mental health. To ease the pressure on acute inpatient services, those service-users who are ill or have just come out of hospital are seen at home by a “home treatment team” or “crisis resolution teams.”

These patients might prefer to be treated in the community rather than hospital, but it’s debatable as to the quality of care they receive.

This is due to the shift patterns the teams work, meaning staff continuity can’t be guaranteed. This lack of continuity of care means true therapeutic relationships, so crucial in mental health care, can’t be established.

Often service users have to repeat time and time again, their history, which not only is distressing but a stark reminder of the lack of knowledge the staff members have in terms of the clients in front of them.

It is hardly surprising that such teams in mental health have been associated with poor outcomes, including, tragically, an increase in suicides.

Both the example in mental health and what is proposed for housebound patients are due to a wider malaise in the NHS, with the fragmentation of care in primary and secondary services a symptom of wider problems in health and social care.

Burdened with an increased number of patients and a lack of resources, the result is often poor care or a reduction in the services, which causes both those working in the NHS and their patients much distress.

The further lack of integrated care — with social care not properly resourced or working in partnership with the NHS, commissioners or local GP surgeries — adds more pressure onto the GP, who has to deal with patients often struggling without the right level of care, meaning the GP is called out more often than they should.

The Tories’ long-awaited green paper on social care never materialised and it’s missing completely from their manifesto.

The high demand plus nine years of underinvestment, with an underappreciated and low-paid workforce is hardly the right recipe for the future and causes much anxiety to those working in and receiving services.

This was highlighted by charity director at Age UK Caroline Abrahams, who said: “Some frail and elderly people are likely to be alarmed that the future of GP home visits is even being questioned.

“For older people in this position, knowing you can call out a GP if you absolutely need one provides a precious feeling of reassurance even if you never have to do it.”

Jonathan Ashworth, who prior to the calling of the general election was the shadow health secretary, said the Labour Party’s plan was to recruit and train more GPs so that home visits can continue.

He said: “The crisis in the family doctor service is just one more area where the Conservative government has let down patients and the NHS.

“In 2015 they promised more GPs, which like their pledges on everything else, never happened. And now there is a serious threat that elderly and vulnerable patients who rely on home visits will have that vital support removed.”

Ruth F Hunt is an author and freelance journalist.

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