Overview

We work from the Local Medical Committiee's definition of housebound patients, to encourage people, who are able, to attend clinics for their appointments and to limit the use of home visits. This aims to ensure that community nurses and GP clinical teams are providing routine clinical appointments in the home setting only when it is appropriate. Patients assessed as not meeting the criteria for housebound will be expected to attend a clinic or surgery setting. It is acknowledged that an individual’s needs may change and therefore eligibility for a home visit should be reassessed on a regular basis. Some patients may not be housebound permanently but rather are housebound temporarily, as a consequence of an episode of illness.

Definition

A patient is deemed to be housebound when they are unable to leave their home environment (which may include a residential care setting) through a physical or psychological illness. This can be a temporary or permanent position. An individual is not considered housebound / eligible for a home visit if they are able to leave their house on their own, with minimal assistance or support. For example: assisted / unassisted visits to the dentist, hairdresser, supermarket or other shopping, social events or hospital outpatients. 

Clarification

Minimal assistance would be described as: a person who can leave their own home and travel to a clinic appointment in a vehicle such as a personal car, taxi or public transport adapted for their use or not and with or without the use of a wheelchair either by themselves or with an escort.  We have many patients who attend surgery in wheelchairs or with walking aids. If you would like to use the surgery wheelchair to get from our carpark, please ask at reception. We make every effort to fit appointment times around your accessibility issues.

To avoid confusion any person who requires a specialist vehicle (Ambulance) or a two-person escort would be regarded as housebound.

To avoid further confusion a person will not be regarded as housebound should they require a companion to leave the house but not have one available.

 Principles

• Ultimate responsibility to determine whether a patient requires a home visit, rests with the assessing clinici
• Each patient’s eligibility for home visits will be individually determined at each request.
• Patients assessed as not meeting the criteria for housebound will be expected to attend a clinic or surgery setting.
• The assessment for housebound will ensure a holistic approach including assessment of the patients’ physical, social and psychological needs.
• Individual circumstances will be monitored and where an individual and/or Health care Professional assesses that the patient’s needs have changed due to either  an acute onset of illness or gradual deterioration in their conditions, the patient’s housebound status will be reviewed.”
  
  

Eligibility

Each patient’s eligibility for home visits will be determined by a clinician, based on the above definition. Patients assessed as not meeting the criteria for housebound will be expected to attend a clinic or surgery setting. Patient's circumstances will be monitored and where an individual and/or health care professional assesses that the patient’s needs have changed, the patient’s housebound status will be reviewed.

A GP will assess your condition and advise on the most appropriate person to see you: most of our visits are now done by our Primary Care Visiting Service (known as the Ageing Well Team). Inspire Health GPs will visit when their particular skills are needed or when the Ageing Well Team has reached visit capacity.

You may also be visited at home by a community nurse if you are referred by your GP. You may also be visited at home by a health visitor if you have recently had a baby or if you have preschool children and have specific needs or checks best managed by seeing you at home.

Benefits

• The implementation of the definition of housebound will bring the following benefits:
• Patients who are not able to travel to a clinic or surgery and need to have their care delivered at home are seen in a more timely and efficient way.
• More clinical care is delivered in the best setting for delivering safe care – with proper equipment and better facilities for examination and treatment
• Patients requiring appointments with multiple clinical teams (ie nurse for health review and pharmacist for medication review) can usually have these aligned when attending the practice.
• Time of clinical teams is most efficiently and cost-effectively utilised.