The domiciliary consultation service: time to take stock

Abstract

Objective: To review the use of the domiciliary consultation service in modern clinical practice in the Northern region.

Design: Retrospective study of data on domiciliary consultations from claim forms for payment submitted to the regional health authority by consultants during 1984-5 and prospective study during 1985-9. Peer review of patterns of practice by consultants.

Setting: 15 Of the 16 health districts in the Northern region, comprising a mixed urban and rural population of about 2.8 million.

Participants: 760 Consultants in 28 specialties and 1666 general practitioners who were eligible to perform or request domiciliary consultations.

Main outcome measures: Numbers of domiciliary consultations, general practitioners' requests for consultations, and consultants performing consultations and expenditure on the service by the region.

Results: Use of the domiciliary consultation service in the Northern region declined by 53% between 1984-5 and 1988-9, considerably in excess of the national rate of decline of 27%, and expenditure on the service was reduced, after allowing for inflation, by 604,000 pounds, or 38%, in real terms. Most consultants and general practitioners used the service sparingly whereas a small proportion used it heavily; a few specific consultants and general practitioners were responsible for a relatively high rate of domiciliary consultations. Contrary to the original definition of domiciliary consultation, the general practitioner accompanied the consultant on only one occasion in 17 and, in one specialty examined (paediatrics) patients who received domiciliary consultations seemed to have minor medical problems.

Conclusions: Peer review examination of the pattern of practice in the domiciliary consultation service proved effective in rationalising use of the service, although a substantial minority of consultants and general practitioners continued to use the service heavily. The place of the service in modern clinical practice would benefit from a national review.