Standards for general practices

General practice module

Criterion GP1.2 – Home and other visits

        1. Criterion GP1.2 – Home and other visits

Indicator


GP1.2 A Our patients can access home and other visits when safe and reasonable.

Why this is important

Patients value an ongoing relationship with their general practitioner (GP), even when their needs change.

Patients who are in residential aged care facilities, residential care facilities, or hospitals also need to be able to access care from your practice.

Meeting this Criterion

You need to consider how to provide continuity of care to patients who are not able to physically attend the practice.

Who can perform home or other visits?

A member of the clinical team normally performs home and other visits. A GP is required in most situations, while a nurse may be able to perform the required duties in other situations. At times, it is appropriate for other health professionals, such as nurses or Aboriginal and Torres Strait Islander health workers/practitioners, to attend home visits under the supervision of a suitably qualified doctor.

Visits may also be performed on behalf of your practice (eg by services that provide care outside of normal opening hours). In this situation, there must be a direct and continuing relationship between your practice’s GPs and the nominated after-hours service that performs the home or other visits on their behalf. This includes arrangements to exchange clinical details about the patient’s care and any concerns your practice may have about the visiting clinician’s safety.

Making home and other visits

It is appropriate to visit patients at home or in another setting, instead of them coming into the practice, when:

  • the patient is confined due to illness or disability
  • urgent treatment can be provided more quickly
  • you want to reduce the risk of infection.

To determine the circumstances in which a home and other visit is offered, your practice could have policies that specify:

  • factors to be considered when deciding if a visit to a home or other setting is safe and reasonable
  • geographical limits for home and other visits
  • personal circumstances and health concerns that necessitate a home visit
  • possible alternative arrangements if a home or other visit is not available.

GPs and other members of the practice team need to know the conditions in which a home or other visit is deemed appropriate according to the practice’s policy.

Defining ‘safe and reasonable’ in the local context

Your practice needs to decide what is ‘safe and reasonable’ in your local context, with consideration of your practice’s location and patient population. To determine if a home or other visit is ‘reasonable’, consider:

  • if it is clinically appropriate to conduct a home visit
  • whether it is safe to conduct a home visit based on issues such as potential for violence or risk of infection
  • whether the circumstances mean the patient needs to be visited at home instead of coming into the practice.

One approach is to consider what your peers, particularly those in the same area, would agree is safe and reasonable.

Your practice team needs to manage the risk of cross-infection during a home visit as they would at the practice (see Criterion GP4.1 – Infection prevention and control, including sterilisation). This includes:

  • ensuring practice team members who will be conducting home visits have the skills to assess the risk of transmission of infection and determine the type of precautions required to minimise that risk
  • providing PPE to all members of the practice team who will be conducting home visits
  • pre-screening patients and other third parties who will be present at the appointment for symptoms, as routine clinical assessment
  • ensuring that clinicians themselves are not a risk to patients and other third parties (ie consider individual clinician’s infection or exposure status prior to conducting a home visit).

Additional risk-screening and mitigation measures will need to be put in place in the event of a pandemic or local disease outbreak, including minimising close contact and the number of people present during the home visit.

Alternatives to home or other visits

When a home or other visit is neither safe nor reasonable, your practice must be able to describe an alternative source of care that the patients can access, such as telehealth or video consultations, access to locums or after-hours services, or GP telephone advice lines.

When determining alternative systems of care, you could consider what other practices in your area do when a home or other visit is neither safe nor reasonable.

If your practice uses another service to provide an alternative source of care, you must obtain:

  • documented evidence from that service that they are, in principle, able and willing to provide care for your patients when a home or other visit is neither safe nor reasonable
  • documentation regarding the care they have provided to any of your patients (an after-hours service must provide their report the morning following a consultation).

Another option is to conduct a video consultation. In deciding whether to offer video consultation services as an alternative to face-to-face consultations, you need to consider:

  • patient safety
  • patients’ clinical needs
  • clinical effectiveness
  • patient preference
  • location of the practice
  • availability of telehealth facilities
  • conditions of your professional indemnity insurance.

Meeting each Indicator

GP1.2 A Our patients can access home and other visits when safe and reasonable.

You must:

  • record in patients’ health records when team members have made visits to homes and other settings
  • tell patients about how they can access care when a home or other visit is neither safe nor reasonable, and provide evidence that these conversations have occurred.

You could:

  • You could:
    have a policy explaining the circumstances that would make a home or other visit safe and reasonable.

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