Domiciliary visits to the old and the mentally ill: how valuable?

In the early days of the British National Health Service, domiciliary visit s were a continuation of the tradition whereby general practitioners (GPs) met consultants in the patient's home. The nature of domiciliary visits, wh ich still attract a special fee, has since changed. We analysed the effecti veness of all domiciliary visits undertaken in a NHS trust providing primar y care, mental health and elderly care services to a population of 470 000. Data were obtained from domiciliary visit claim forms and from questionnai res completed by the consultant, the referring GP and consultant peer revie wers. The largest number of visits (total 234) was in geriatric medicine 48.9%, f ollowed by old-age psychiatry 44.9%. Geriatric medicine was more likely tha n psychiatry to admit patients to hospital (19%) after a visit. All domicil iary visits in old-age psychiatry were done during the day (9am to 5pm). On ly 2% of Gps stated that they attended any of the domiciliary visits; almos t all thought that the outcome of domiciliary visits was of value. Old-age- psychiatry peer reviewers believed that all visits in that specialty were a ppropriate; in geriatric medicine this figure was 77% and in other psychiat ric specialties 65%. The findings indicate that domiciliary visits were not being used routinely as a pathway to hospital admission, though they were often used to expedit e admission or gain a quick consultant opinion; the visits were valued by G ps. The practice of domiciliary visits differs greatly from the definition in NHS terms and conditions of service. One or other should be altered.