Dr Mary McCarthy: Home visits are all part of the day's care
As the one-o-clock news kicks in on the car radio, I pull in for my first home visit of the day.
Although GPs will always encourage patients to come into the surgery as this is where we can provide the best care – an ageing population means that a growing number of patients are unable to make the journey and need to be seen at home.
This is the case for my next patient who's had diarrhoea and vomiting for a number of days and his symptoms have not reduced in any way. As he has recently returned from a business trip abroad, we need to send samples to the laboratory for analysis.
There are also great advantages to a home visit as you can discuss the plan of care with both the patient and their family.
My patient's family are keen that treatment is started to relieve his symptoms so I write a prescription for them to take to the chemist and reiterate basic hygiene measures. It is important to keep his fluid intake adequate and we discuss how long he needs to keep away from work.
His wife says she will make sure he rests, I decline their kind offer of a cup of tea, and get back in the car to work out my route to the next visit at the local nursing home, where three patients have asked for visits.
We work very closely with the home, so know the staff and patients well. The senior nurse came to meet me, chart in hand – the first patient is coughing and, she thinks, may have a chest infection.
As a man with Down's syndrome he is prone to chest infections and in previous years people with this genetic disability were not expected to live much beyond their twenties. Improvements in their medical management and care mean that it is not unusual for them to reach old age, as this patient has.
In Europe the elderly are often the responsibility of a Community Geriatrician or in Holland a nursing home doctor. A Dutch doctor told me that family doctors there often take this up at the end of their careers – "You have to have a grey heart and grey head to care for old people" is their motto – but in the UK the elderly, as far as is possible, remain with their family doctor.
While this has great advantages, incredible pressures on GP services have led to a workforce crisis, with escalating demand having far outstripped capacity.
A new survey from the British Medical Association shows that a third of GPs are considering retiring from general practice within the next five years, while one in five GP trainees are considering working abroad .
In our campaign, 'No More Games', we are calling on politicians to stop playing games with the NHS. We need a debate about the future of general practice, or we could have a situation where we do not have enough GPs to deliver effective care.
