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

There is a curious sentence in Negi et al's paper about psychiatric out-patient clinics for older adults. ¹ When they refer to Benbow's paper about community clinics, ² 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. ³ 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. ⁴

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. ⁵ 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.