Top 10 qualities of an after hours GP home visit service in Perth

About the author: Dr Richard Austerberry is co-founder of Night Doctor. He is a medical practitioner and software developer, and is passionate about innovating in healthcare to improve care and customer service for patients.

Artist: @ellieloomes

You're sitting at home with a sick child on your lap who needs to see a doctor, but it's 6pm and you're wondering 'Who's the best after hours GP in Perth?'.

In Perth alone, there are plenty of home doctor services providing care to patients on weeknights, over the weekend and on public holidays when many GPs are not available. With so many services to choose from it can be hard to know where to start.

There are some big differences between services which potentially affect the quality of care and customer service you receive. In this short article, I go over 10 important things that you should think about when choosing a home visit GP.

1. Doctors with the right experience
2. Honest arrival times
3. Doctor triage
4. Length of consultations
5. Western Australian owned and operated
6. No late night pharmacy trips
7. Patient education resources
8. Critical equipment: being prepared for anything
9. The doctor’s assistant
10. Good communication with GPs and emergency services

1. Doctors with right experience

Having the right clinical experience is critical to performing well as a home visit GP. Paediatric experience is particularly important as sick children account for around 50% of doctor call outs. It is common for house doctor services to employ GPs as well as GP trainees and hospital doctors at various stages of their training.

A home visit doctor must be able to:

• diagnose and treat common acute conditions in adults and children

• determine if you are too unwell for home management and require urgent investigation in the emergency department (ED)

• competently manage you in your home when you are well enough to stay out of hospital. A lack of experience results in doctors referring patients to hospital unnecessarily, resulting in pressure on ED and poor value for taxpayers.

• seek an opinion from a senior medical practitioner for advice on complex cases. Even for more experienced doctors, complex or rarer cases benefit from a discussion with a more senior colleague. Therefore it is essential the house doctor service has a senior GP on-call at all times.

It is also important that a home GP has experience in the Australian healthcare system as this leads to a good understanding of how the system works which in turn leads to better healthcare decisions for patients.

When choosing an after hours GP you should try and understand which doctors work for the service, and what steps the company takes to select their doctors.

2. Honest wait times

It’s natural for you to want an after hours doctor visit without having to wait a long time, especially if it’s for your child who is unwell and approaching their bed time. Unfortunately, despite the many promises made of short wait times by some home doctor services, the reality on the ground can be very different.

Some services routinely inform you that they will get a doctor to your door within 1-2 hours to encourage a booking, irrespective of how busy their doctors are. We regularly hear stories of patients expecting a short wait in the early evening, only to be told that their doctor cannot visit until the next morning at 6am.

You can get a good idea of how companies are going to look after you by reading their google reviews. Choose a company that is honest about their estimated arrival times and updates you about any delays so if you are up for a wait, you can know this early on and can plan.

3. Doctor triage

Doctor triage is a process where doctors review a patient’s medical problem to understand if they are safe to wait for a home visit GP, or must instead go to the Emergency Department (ED). This is important, as a lot of patients don’t have the experience or knowledge to make this decision for themselves.

A responsible home GP service will:

• train their receptionists to recognise emergency medical conditions

• have a doctor or nurse available to speak immediately with you if you might require emergency treatment, so you can be directed to the ED if needed

• have a doctor or nurse screen your medical problem as you book in, to be sure no potential emergency has been missed by the receptionist and you are safe to wait to get a doctor to your door

• get your home doctor to call you before they attend if you have a serious medical problem, to check on your condition, make sure your're safe to wait and to offer initial treatment advice

Unfortunately, not all home visit GP services have such safe processes in place, so you should choose carefully, especially if you are feeling very unwell.

It’s important to stress that home doctor services are not emergency services. Emergency complaints such as difficulty breathing or chest pain must be managed in the ED.

4. Length of consultations

A common complaint made by patients is that the doctor did not spend enough time with them in the consultation. Unfortunately, some home visit doctor services prioritise the number of cases they review in a shift over the length and quality of the consultations.

Longer consultations typically lead to better care, as more time can be spent by the doctor diagnosing and managing your medical problem, and there is more time for you to ask questions. Of course, a balance needs to be had, as the longer consultations are, the longer you may have to wait for your doctor to arrive.

A good way to make sure you are getting the attention you or a loved one needs, is to choose an after hours GP who will call you to discuss your condition before they attend. This approach means the doctor can take your medical history whilst they are on the road and spend more time in your visit managing your condition and answering your questions. This approach provides a longer consultation time whilst keeping waiting times to a minimum.

5. Western Australian owned and operated

Some of the after hours doctor services operating in Perth have services elsewhere in Australia, and have call centres based in the eastern states.

By choosing a local service, you not only create and support jobs for Western Australians, but also deal with staff with good knowledge of the company’s service area and local healthcare services (e.g. Emergency Departments) which can lead to a better healthcare experience.

6. No late night pharmacy trips

Most house doctors carry medications to get you started on treatment for common medical conditions so you don’t have to worry about making any late night pharmacy trips.

However, some companies carry a greater range of medications than others. The larger the range of medications they carry, the more likely it is they can start you on treatment for less common illnesses, as well as providing you with the best medication possible for your condition based on local and national best-practice guidelines.

7. Patient education resources

As any patient who has visited a doctor will know, the consultation is only a small part of the healthcare journey for any given illness. Once the consultation is finished, it’s left to the patient, carer or guardian to manage the illness.

Good doctors will educate you on how best to manage your condition and provide clear instructions about follow-up, if required.

High quality and evidence-based patient guidelines are key to managing some conditions well and safely, and are a good marker of the quality of an after hours doctor service. If a service has put the time and resources into creating quality education material, then there is a good chance they will make the right efforts by you in the rest of your healthcare journey with them.

8. Critical equipment: being prepared for anything

Home GP services are not emergency services and patients with emergency conditions should be managed in the local ED. However, a patient’s condition can potentially deteriorate quickly, therefore it is essential that a home visit doctor carries equipment to deal with any eventuality.

Two essential pieces of equipment for dealing with emergencies are medical oxygen and a defibrillator. Any responsible service will carry these so they can look after deteriorating patients (e.g. those requiring resuscitation) before an ambulance arrives to take them to hospital. Although this will not happen often, it could mean the difference between life and death if the right equipment is not to hand.

9. The doctor’s assistant

Some home visit GPs have drivers accompany them on the road. This allows the doctor to be more efficient which means they are able to look after more patients in a shift. However, better still, some services have a doctor’s assistant who provides additional support.

Doctor assistants not only drive, but are also trained to offer clinical support (e.g. helping take a patient’s blood pressure) and clerical support (e.g. helping fill out paperwork). This allows doctors to spend more time diagnosing and managing your condition which typically leads to better care.

10. Good communication with GPs and emergency services

Patient care is significantly improved when healthcare professionals communicate well. This is especially relevant for after hours GP services, which look after patients on behalf of their GP when they are not available.

It is important that GPs receive your home doctor’s consultation notes in a timely manner, so that if you require follow-up, your GP can understand what management has occurred. Without this information, it can be very difficult for them to manage your condition.

Some patients after undergoing a home visit assessment have to be referred to the Emergency Department (ED). If your home GP refers you to the ED they should provide a referral letter that clearly explains your medical problem and why you have been referred.

If a house doctor has to call an ambulance to take you to ED and you are very unwell, they should stay with you until the ambulance arrives to provide ongoing care and to hand over to the paramedics on their arrival.

Services that do not take care to communicate your medical problem with other healthcare professionals or services do you a disservice and potentially jeopardise your care.