The national LMC conference caused a stir in the national press last week when they passed a motion instructing the GPC to negotiate the removal of home visits from the core contract.

Hardly surprising given the timing and the forthcoming election, with each of the main parties falling over themselves to say how many extra GPs they are going to train and recruit should they be elected (Conservatives an extra 6,000 GPs, Labour and Lib Dems an extra 5,000 GP training places).  And of course it was easy for the press to sensationalise the story as an “end to home visits”, and for Matt Hancock to reject that notion out of hand, when that was not what the conference voted for.

So what did they vote for?  The specific motion was:

That conference believes that GPs no longer have the capacity to offer home visits and instruct the GPC England to:

1. Remove the anachronism of home visits from core contract work (passed 54%-46%)
2. Negotiate a separate acute service for urgent visits (passed 74% to 26%)

• Demand any change in service is widely advertised to patients (passed 90% to 10%)

Let’s be clear, the motion was not really about the merits or otherwise of home visits.  It was about GP resourcing and workload.  Despite the existing promise of 5,000 more GPs, the number of GPs has gone down while the workload has continued to rise, at a rate exceeding any increase in funding.  And so, inevitably, we end up with motions like this, which are statements that the current situation is unsustainable.

Something needs to be done.  I don’t think many of those at the conference believed the GPC would be able to negotiate such change to the contract, but rather they wanted a line drawn in the sand.

If the contract itself isn’t going to change, what can be done, and can the visiting system be changed to reduce pressure on GPs?

It is interesting that the level of support at the conference was so high (74%) for the introduction of a separate service for urgent visits.  Whilst some portray the debate as one of access versus continuity, this is snot necessarily the case.  Most current visits by a practice will not necessarily be by the patient’s own GP.  There are systems that have developed in different places around the country where a paramedic or nurse practitioner report back into the surgery before, during and/or after carrying out a home visit.  It does seem there is mileage in such a system that could potentially (according to the LMC conference debate) release 2 hours a day of time for practices.

Of course, not all visits are equal.  Many GPs in the debate have drawn the distinction between urgent on the day visits particularly requiring a “convey to hospital or not” decision, and the scheduled complex visits for very frail elderly people, those with severe disabilities, and those at end of life.  An acute visiting service would be for the former of these types of visits only.

What interests me is why practices are not planning to use the new roles coming via the PCN contract to set up such a service.  The LMC conference gave its own verdict on PCNs, passing a motion that PCNs would not reduce GP workload and would not address the workforce crisis.  But if practices chose to use the new PCN roles in the way they are asking for in relation to visits, it does seem as if PCNs could have an impact.

If the conference had slightly amended its motion as follows, NHS England may have potentially been more receptive:

That conference believes that GPs no longer have the capacity to offer home visits and instruct the GPC England to:

1. Shift the requirement of home visits from core contract work to the PCN contract
2. Negotiate sufficient resources for PCNs to establish an acute service for urgent visits

• Demand any change in service is widely advertised to patients

Would this, though, have garnered the same media reaction?  Would it have drawn the line in the sand that the LMCs were seeking?  Unlikely.

But do practices within a PCN require such a motion to be passed?  What is stopping them from deciding for themselves that this is how they are going to use the new roles that are being funded within their PCN?  I doubt local commissioners would get in their way.  Indeed, I suspect such an initiative would be welcomed, and could even attract additional local resource.  The bigger barriers are internal: the change capacity within PCNs; and of actually making change happen across multiple practices.

Relying on the promises of the major political parties to resolve the challenges in general practices is unlikely to be any more successful in the future than it has been in the past.  Whatever the right changes to make are, the best ones are going to come from within the service itself.  If 74% of an LMC conference believe an acute visiting service will help, maybe now is the time to push ahead with its implementation.