The 10-minute appointment

In an RCGP news item¹ issued to coincide with the publication of the discussion paper Patient safety implications of general practice workload,² reference is made to the ‘constraints of the standard 10-minute GP–patient consultation’. The paper itself discusses the safety implications of fatigue, and states that individuals are more likely to make mistakes when ‘late’, but there is no mention of the role of the 10-minute appointment.

It is implausible that extra funding or staffing in primary care would reduce the number or complexity of the problems which patients wish to discuss in an appointment, so should we reconsider the use of the 10-minute appointment?

Why have 10-minute appointments become a problem? Some of the causes are beyond our control: an ageing population with multiple comorbidities, a shift of care from secondary to primary care, and increased patient expectations. Others are a direct result of changes we have made: by delegating routine reviews, minor illnesses, and other straightforward cases to other healthcare professionals. And by using 5-minute telephone consultations instead of face-to-face reviews we have pruned the ‘quick’ consultations from our own surgeries and left our lists full of complex physical problems and time-consuming psychosocial issues. For medicolegal reasons we also spend longer documenting our consultations. Busy patients, not unreasonably, hope that we will deal with all their problems at one appointment, and when we ‘run late’ our waiting patients have time to convert their various ailments and concerns into a very concrete problem list.

When a patient’s problem(s) are not able to be safely and effectively dealt with in a 10-minute appointment there are only three possible outcomes: the problems are not adequately dealt with, they are dealt with but take longer than 10 minutes, or the patient is asked to make a further appointment. All of these outcomes are bad for patients and stressful for doctors.

If we could improve both patient care and GP morale by increasing the length of our appointments, what have we to lose? If instead of having 18 10-minute appointments we have 18 12½-minute appointments our surgery would be 45 minutes longer, but that would be partly offset against the time we normally ‘run late’ and a reduction in repeat appointments. We might worry that ‘quick’ consultations or patient DNAs would cause wasted GP time. In reality, there are jobs that we can do without leaving our desks that are quick and interruptible: post, pathology results, prescriptions.

Changing appointment length is simple to trial, and reversible. As GPs seeking ‘the courage to change the things we can’, should we now seek to improve patient care and reduce our own stress levels by consigning 10-minute appointments to the history books and declaring that they are no longer fit for purpose?

• © British Journal of General Practice 2015