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Doctors in the house. Home visits for older people: a practical model outside Yorkshire

Published online by Cambridge University Press:  02 January 2018

Susan Mary Benbow
Affiliation:
Centre for Ageing and Mental Health, Staffordshire University, Blackheath Lane, Stafford ST18 0AD, email: [email protected]
David Jolley
Affiliation:
Pennine Care NHS Foundation Trust, and Manchester University Personal Social Services Research Unit
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Abstract

Type
The columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2009

There is a curious sentence in Negi et al's paper about psychiatric out-patient clinics for older adults. Reference Negi, Seymour, Flemons, Impey, Thomas and Witrylak1 When they refer to Benbow's paper about community clinics, Reference Benbow2 they state that ‘this model has not been adopted either in rural or urban catchment areas’. No evidence is quoted for this sweeping statement.

Admittedly, in our fast moving National Health Service it is difficult to keep track of changes. In 1997 we investigated the work of old age psychiatrists. Reference Jolley and Benbow3 Every day of the week community clinics were reported by 20% or more of respondents (the corresponding figures for hospital out-patient clinics ranged between 17 and 28%). Additional community activity was undertaken as domiciliary visits and new home visits. Domiciliary visits are well-defined: they incur additional payment and occur at the request of the general practitioner, normally in his or her company, to advise on diagnosis or treatment, where the patient cannot attend hospital on medical grounds. Home visits can involve follow-up or new assessments and are undertaken without additional remuneration as part of the doctor's working day.

We later reported a more in-depth analysis which found that community activity was greater among consultants working with colleagues in comparison with those who worked alone. Reference Benbow and Jolley4

Since then, Richardson & Orrell have reported that home assessments are popular with patients, carers and professionals, going on to argue that they also provide more information. Reference Richardson and Orrell5 The College Faculty of Old Age Psychiatry seems to think community clinics are normal practice. 6

In all the services we have worked in, home visits carried out during community clinics have been the norm – but then neither of us has worked in Yorkshire. Visits are efficient and cost-effective, with non-attendance rates consistently lower than 10% in our services, as well as providing the continuity of follow-up desired by patients, carers and colleagues in primary care and social services, and in line with the National Dementia Strategy. 7 It is important that Negi et al set the record straight: in many good services for older people home visits are the reality.

References

1 Negi, R, Seymour, J, Flemons, C, Impey, M, Thomas, N, Witrylak, R. Psychiatric out-patient clinics for older adults: highly regarded by users and carers, but irreplaceable? Psychiatr Bull 2009; 33: 127–9.Google Scholar
2 Benbow, SM. The community clinic – its advantages and disadvantages. Int J Geriatr Psychiatry 1990; 5: 119–21.Google Scholar
3 Jolley, DJ, Benbow, SM. The everyday work of geriatric psychiatrists. Int J Geriatr Psychiatry 1997; 12: 109–13.Google Scholar
4 Benbow, SM, Jolley, DJ. Gender, isolation, work patterns and stress amongst old age psychiatrists. Int J Geriatr Psychiatry 1999; 14: 719–25.Google Scholar
5 Richardson, B, Orrell, M. Home assessments in old age psychiatry. Advan Psychiatr Treat 2002; 8: 5965.Google Scholar
6 Faculty of Old Age Psychiatry. Raising the Standard. Specialist Services for Older People with Mental Illness. Royal College of Psychiatrists, 2006 (http://www.rcpsych.ac.uk/PDF/RaisingtheStandardOAPwebsite.pdf).Google Scholar
7 Department of Health. Living Well with Dementia: A National Dementia Strategy. Department of Health, 2009.Google Scholar
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