A practice-based survey of home visit requests

Home visiting has long been regarded as a key element of NHS general practice. In recent years the number of home visits has fallen significantly, both in the UK and elsewhere in Europe, relative to its historic peak in the 1980s.¹ However, it looms high on the list of aspects of our work that divides opinion,² and not all are convinced of its benefits.³

Indeed, as recently as November 2019, the Local Medical Committee (LMC) conference debated the current contractual requirements and a motion was passed to instruct the General Practitioners Committee (GPC) to ‘remove the anachronism of home visits from core contract work’;⁴ however, there were also opposing voices,⁵ and the GPC were not successful. Shortly after this, the Covid-19 pandemic significantly changed consulting patterns, with phone, video and SMS consultations considerably increasing their share of the methods of doctor-patient communication.⁶

This is a practice-based study of home visiting conducted at Gade Surgery, an 8-doctor teaching and training surgery with a list size of 12,000, based at two sites in Rickmansworth and Chorleywood, Hertfordshire commuter towns to the North-West of London.

In June 2025 the practice merged with a neighbouring practice, Chorleywood Health Centre, forming the Gade and Chorleywood Practices with a total list size of 19,400. Visiting requests typically arise from patients in their own homes, residents in supported accommodation and care home requests that fall outside of the weekly care home ward rounds.

Methods

This study was conducted at Gade Surgery shortly before the merger. All home visit requests made in April 2025 were analysed. Data was collected on the following:

• The number of visit requests
• The gender and age of patients making requests
• The number that resulted in an actual visit
• What methods were used to attend to those who were not visited
• Analysis of patients making multiple requests
• Whether any complications arose from not being visited in person

Data was gathered from the electronic patient record (Emis). A total of 60 requests were received; however, on analysis of the notes, six requests were excluded due to restrictions on accessing their electronic records. Therefore, a total of 54 visit requests were included and reviewed.

Results

In April 2025, 54 visit requests were made by 48 patients; 30 (55.6%) resulted in an in-person visit. Table 1 summarises the demographic characteristics and overall outcomes. More requests (35/54; 64.8%) were made by female patients than by male patients (19/54; 35.2%).  The average age of all patients requesting visits was 81.5 years (range 47 – 96). For male patients, it was 77.4 years (range 47 – 94), whilst female patients averaged 84 years (range 54 – 96).

Table 1: Characteristics of home visit requests (April 2025)

Over half of the requests (55.6%) resulted in a face-to-face visit. Of the remaining 24 requests that were not visited, the vast majority (87.5%) were managed by telephone consultation alone; one patient self-referred to the emergency department, one was subsequently seen in the practice, and one dermatological problem was managed via an emailed photograph and a telephone consultation.

Table 2. Outcomes of requests not resulting in a visit (n=24)

Over this period in April 2025, six patients made multiple requests: five made two visit requests each, and one made three. The person who made three requests did so because of two unrelated problems; this led to two home visits and one phone call to resolve the matter.

In three of the other cases, the second visit request related to the original call but was resolved by phone. In one case, a patient with back pain, whose original request was managed by a phone call followed by a prescription for analgesics, a subsequent visit was done due to failure to improve, but this did not result in any change of diagnosis, nor any harm to the patient.

Conclusion and discussion

The authors acknowledge the limitations of this modest single-practice dataset; however, and especially given the significant number of multiple requests, this does reflect the unique and unpredictable pressure that visits still generate.

Unsurprisingly, most requests were made by and for older people; however, a significant difference in the frequency of calls and in age between the male and female cohorts was evident, probably reflecting the greater number of very older women than men. Indeed, the average ages in our cohort are comparable to the latest figures for life expectancy: 78.8 for males and 82.8 for females.⁷

Just over half of the requests led to a visit, supporting the common practice of using triage as a vetting system, and the data suggests that this is safe to do if due consideration is given to the problem(s) presented. While resource implications are evident, home visits continue to offer unique value for holistic assessment and reassurance, particularly for the frail or socially isolated.

Faced with a GP workforce whose whole-time equivalents have shrunk by 15% in a decade,⁸ primary care cannot absorb any increase in visit requests, which, were this to happen, would almost certainly necessitate having separate, multi-disciplinary teams devoted solely to this purpose. It would be valuable to examine patient experiences alongside clinical outcomes and larger, multi-practice surveys to help determine how representative these patterns are across different communities.

Sustaining safe and equitable home visiting will require clear policy direction that balances patient needs with workforce sustainability.

Edin Lakasing, GP, trainer and tutor, Gade and Chorleywood Practices

Aparna Joshi, GP, Gade and Chorleywood Practices

Suthan Thangarajah, GP, trainer and tutor, Gade and Chorleywood Practices

Competing interests: none.

References

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7. Office for National Statistics. National life tables – life expectancy in the UK: 2021 to 2023. ONS, https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/bulletins/nationallifetablesunitedkingdom/2021to2023additionaldata (accessed 19 Sept 2025)
8. Pettigrew LM, Petersen I, Mays N, et al. The changing shape of English general practice: a retrospective longitudinal study using national datasets describing trends in organisational structure, workforce and recorded appointments. BMJ Open https://bmjopen.bmj.com/content/14/8/e081535 (accessed 19 Sept 2025).

Dr Edin Lakasing

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