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Home visits can be daunting..

Home visit can be daunting, occasionally turning into an Indiana style mission, hunting for the missing door numbers on a street that defies any conventional numbering system, dodging the family pit bull, navigating past the deathly stair lift and finally finding the treasured granny set in a deep recess, bathed in the musk of the ancients.

Due to the challenge, some locum GPs defer these, however with a change in mindset and proper preparation, offering them can be a great help to surgeries and also a good supplemental income for the locums themselves.

Here are my top 10 tips and tricks!

1)  When asked to pick a couple of cases from an assortment, look at the postcodes to try to find a pair near to each other and also consider the reason for the visit.

2)  Receptionists have a wealth of knowledge; ask them about the patient, you will garner information that is not in the records.

3)  You will in most cases be given a brief summary printout, ask the surgery to address stamp the lower back of this. If the patient needs admitting just scribble clinical information on this to go with the patient to the hospital.  The stamp will also have the telephone no of the surgery should you need to ring the receptionist to arrange an ambulance transport.

4)  Ring ahead, just spending a few minutes on the phone with the patient will:

– Allow you to check computer records to pick up any crucial info e.g. blood results, clinical letters etc
– 10-20% of cases you may be able to deal with the matter on the phone or patient will come in.
– Alert them that a “stand in doctor” will be attending so they do not freak out when you come calling.

5)  Drive modest car flash cars and private number plates will attract the wrong attention.

6)  In the case of seeing someone with a history of violence or psychosis, you may want to ask the receptionist to call when you are on site or you may wish to have the police in attendance.

7)  Insist on pets being locked away. Even the most cordial dog or parrot can pounce if they see their master being prodded by a stranger.

8)  Like a cub scout, be prepared, having the right equipment will not only make you more confident but also safer:

–  Stethoscope and pocket diagnostic set.*
– Sphygmomanometer and infrared thermometer.*
– Pulse oximeter.*
– Glucometer including appropriate strips and lancets*.
– Alcohol wipes, gloves, lubricating jelly*.
– Alcohol gel for hands*.
– Multistix for urinalysis* pregnancy test kit.*
– Tongue depressors, preferably wrapped.*
– Reflex hammer.
– Small torch.
– Peak flow meter, preferably low-reading.
– Specimen bottles (urine/faeces) and swabs.

9)  Safety net, I usually advise the patient on what to do if their condition does not improve or if they become unwell acutely to call 999. If they are being referred to a hospital I will advise them to call 999 if their ambulance has not arrived within a set time.

10)  Always remember to document everything back in the records. If you are not going back to the surgery after the home visit then you can email the PM using a secure mail server e.g. NHS email.
Not recording a home visit is indefensible should a complaint arise.