Consultation length

Consultation length in general practice has long been seriously under-researched given its central importance. The key issue is serious, as Orton and colleagues show that longer consultations are significantly more patient centred and beneficial for patients¹ whereas Elmore and colleagues find no benefit in terms of patient experience from longer consultations.²

Both studies have the advantage of studying substantial numbers of precisely timed consultations, 440 in Elmore and colleagues and 842 in Orton and colleagues. The latter applied an internationally validated instrument for assessing patient-centredness, whereas Elmore and colleagues had the advantage of obtaining patient responses directly.

A weakness in both studies is that they had relatively few consultations lasting 15 minutes or more; only 74 (16.8%) in Elmore and colleagues and 50 (6.1%) in Orton and colleagues. Benefit for patients is likely to be optimised when patients know that they will receive at least 15 minutes and then on average do so, which applied in neither study.

Elmore and colleagues studied practices ‘... below the 25th percentile for mean communication score in the 2009–2010 survey, adjusted for patient case mix’. This group selected for relatively poor communicators probably lacked the consulting skills to give patients a good experience, even with more time. This important limitation was clearly stated in the full version, but did not appear in the two-page printed summary of the article.

We do not believe that results from GPs selected on the grounds of being poor communicators can be generalised. An absence of evidence does not indicate evidence of absence.

Meanwhile, decisions must be taken by managing partners about how long on average patients’ appointments should be. We confirm that in our two very different research general practices patients receive on average 15 minutes or more (mean 16.1 minutes in St Leonard’s). Further research on consultation length is urgently needed.

• © British Journal of General Practice 2017