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Domiciliary consultations: some facts and questions.
BMJ (Clinical Research Ed.)
|July 30, 1988
Summary
The number of home-based patient consultations decreased by 10% between 1981 and 1986, despite an increase in doctors. This decline in domiciliary consultations suggests a shift towards consultant-led home visits, warranting critical evaluation.
Area of Science:
- Health Services Research
- Public Health Policy
- Geriatric Medicine
Background:
- The National Health Service (NHS) domiciliary consultation scheme facilitates joint home visits for patients unable to attend hospital.
- Consultants receive fees for these consultations, while general practitioners do not.
Purpose of the Study:
- To analyze trends in domiciliary consultations in England and Wales from 1981 to 1986.
- To assess changes in the rate of domiciliary consultations per healthcare professional.
Main Methods:
- Analysis of data from the Department of Health and Social Security on domiciliary consultations.
- Calculation of consultation rates per consultant and general practitioner over the study period.
Main Results:
- Total domiciliary consultations decreased by 10% (from 429,759 in 1981 to 387,394 in 1986).
- Despite a 12% increase in consultants and a 10% increase in general practitioners, the rate per consultant fell by 19% and per general practitioner by 18%.
- Geriatric medicine and psychiatry showed the highest rates of domiciliary consultation per consultant in 1986, with most specialties showing a decline.
Conclusions:
- The domiciliary consultation scheme appears to be evolving into consultant-only home visits.
- The observed decline in joint consultations necessitates a critical evaluation of the scheme's cost-effectiveness and purpose.
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