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Just visiting

Still practising

Chris Preece

Friday, 30 August 2019

AdobeStock_115926676_home_blog.jpgI appear to be in something of a minority amongst GP colleagues, in that I kind of enjoy home visits. Yes, they’re time consuming, particularly for some of our more remote patients, but there is a cohort for whom coming to the surgery is genuinely not an option, and visiting at home gives me both a useful insight into the lives of my patients and a convenient excuse to get outside. 

On a good day, it’s an excuse to drive through beautiful countryside with the radio blaring, on a bad day, it’s a cause of additional stress and anxiety as I struggle to get back in time for my next surgery. For the most part I don’t give it much more thought than that.

Occasionally however, I have reason to reconsider my definition of a “bad day”. A few years ago for instance one of my partners was attacked on a home visit. It was entirely unexpected and unprovoked - the assailant, whom he’d never met before, was on him from the moment he opened the door, his doctor’s bag suddenly doubling as a shield. He got out and called the Police, the patient in question was moved to the Violent Patients Service, and everything carried on. We all agreed it was a Bad Thing, but were slightly at a loss as to how to prevent it happening again.

To date I’ve escaped any such attack (I was assaulted working in A&E, but never as a GP). Nonetheless, I remember once sombrely telling a receptionist that I was going to see Mr So and So, but that if I didn’t call them in the next 15 minutes to call the Police. (It’s a long story - there were good reasons both for the concern, and the failure to take any more definitive action.) I have vivid memories of the growing anxiety as I walked up the path to his house in the darkness, and the wave of guilty relief when he didn’t answer the door.

We have some systems to try and mitigate this risk – there are a couple of patients with “do not visit alone” or “not to see female members of staff” tags on their notes – but ultimately, we’re aware that such labels offer only minimal protection, if any. Reducing these risks properly means huge investment - only visiting in pairs for instance – for what is, ultimately, a rare event.

Not rare enough, of course.

This blog has come about because I was suddenly reminded of the precariousness of our position by the tragic death of Belinda Rose. Mrs Rose was a social worker, stabbed to death whilst visiting clients at a multiple occupancy house.

A number of things struck me about this awful story. The first was that I hadn’t really given any consideration to this aspect of social work before. I’ve spent some time shadowing social workers, I know full well that they make visits, but somehow it hadn’t sunk in that these were risky, when, obviously, of course they are. I’m not sure why that is, but I have a horrible feeling it says some pretty bad things about me, and perhaps some even worse things about the way our society views social work as a whole.

I was well aware of the risks to ambulance crews, Police and firefighters, but had somehow not registered the reality that social workers are every bit as exposed – if not more so. This is not due to an absence of statistics. The British Association of Social Workers published a review in June 2018, showing 86% of social workers had been the victims of intimidation, and 50% subjected to physical violence. All of this results in an all too familiar sense of stress and anxiety entering their working lives.

It seems I’m not the only one guilty of not thinking about this enough. Last year saw the introduction of the Assaults on Emergency Workers Act – which gives tougher sentences for those who assault emergency workers – including police constables, prison officers, fire crews, and anyone providing NHS services, but not, seemingly, social workers.

Whilst I’m not entirely convinced doubling the custodial sentence for those assaulting emergency workers will make a jot of difference to the incidence of such attacks (“WelI I was going to throw a brick at a fire engine, but that extra six months in prison has made all the difference” said no-one, ever) – their absence from the legislation is a somewhat insulting omission.

In part I suspect that this is down to a singular failure to acknowledge the role of social workers in emergency situations (when all is working well, they’re a crucial part of a crisis response), but I fear it may also be a failure to acknowledge social workers full stop.

Social work is an incredibly challenging job, horribly underpaid and under resourced with essentially the same aim as the rest of the care sector – to promote and contribute to our collective and individual wellbeing.

Yet, compare the BBC’s reporting of Mrs Rose’s death with the equally tragic death of PC Andrew Harper, a policeman killed on duty a few days earlier. The report of Mrs Rose’s alleged murder doesn’t even touch on the fact she was killed doing her job. What’s more, it’s the only BBC report I could find relating to the incident – whilst PC Harper’s death has at least 10 reports, from the original crime, to tributes and discussions on improving police safety. These are both people who died acting for the benefit of their communities. Yet only one is hailed as a hero – why not both?

Of course, none of this would matter if we could only succeed in making these roles safe in the first place. This is another question that gives me pause. Is it really enough to shrug, and say “these things happen”? If it’s not, then what are we going to do? When I ill-advisedly visited Mr So and So it was a calculated risk – I’m a partner, it was entirely my own responsibility.

However, as I said at the opening, my love of visiting seems to put me in a minority, and the push now is to send ever more people to houses on our behalf. This was the second thing that hit home about her story. As PCNs start to employ paramedics, social prescribers, pharmacists and more to make visits, how do we keep these people safe?

I would like to imagine that Mrs Rose will be remembered as the last of our caring family to die trying to help others. I fear that’s optimistic in the extreme, but we can surely try. In the meantime, I’ll settle for simply remembering her, and saluting all of my colleagues who quietly take on these risks every day.

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Chris Preece

Chris has worked as a GP Partner in North Yorkshire since 2004, and still relishes the peculiar challenge of never quite knowing what the next person through the door is going to present with. He was the chair of his local Practice Based Commissioning Group, and when this evolved into a CCG he joined the Governing Body, ultimately leaving in April 2015. He continues to work with the CCG in an advisory capacity. When not being consumed by all things medical, Chris occupies himself by writing, gaming, and indulging the whims of his children. He has previously written and performed in a number of pantomimes and occupied the fourth plinth in Trafalgar Square. Tragically, his patients no longer tell him he looks too young to be a doctor.
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