Domiciliary rules are extra burden

DOMICILIARY RULES ARE EXTRA BURDEN
I would just like to endorse Robin Dawson's well written letter (July 1) which questions the sense of the new rules requiring prior notification of domiciliary visits. I too undertake home visits to individuals, both through our busy town-centre practice and also occasionally as an individual practitioner covering the area around my home on odd days or evenings after normal practice hours.

Until now the arrangement of relatively impromtu visits, obviously comensurate with the patient's convenience, has worked well. The short notice did depend on factors such as lack of late bookings at work as well as residual energy reserves!

Without this additional burden of long-term planning and extra bureaucracy, the unwillingness of optometrists to get involved with domiciliary work no doubt includes reasons such as: initial outlay and maintenance costs of specialised mobile equipment, challenging working conditions, often difficult patients to communicate with (typically necessitating a patient, imaginative approach).

Add to this relatively poor remuneration - short of being professionally satisfied with a cursory eye examination, individual patients in their own homes can often be seen at no more frequent intervals than around an hour or more (allowing for travel time, finding the address, often moving furniture and setting up/packing away heavy equipment) with the end result quite often being referral and/or no improvement possible or just advice on improved lighting etc - and it is easy to understand why there is such a dearth of domiciliary practitioners.

I would imagine that only the larger domiciliary companies, who in any case have to plan some weeks ahead for staff cover etc, will not be further deterred from continuing home visits. It would certainly be interesting to learn of the views of organisations such as the Macular Disease Society and the Association for the Prevention of Blindness regarding existing domiciliary arrangements and their particular take on these new rules. Personally I find it hard to accept that this further disincentive to take on domiciliary work can possibly help elderly and other housebound people to receive the service that they deserve.
Mike Vickers
Nottinghamshire