Debrief: Consultation length matters

Euan Lawson

doi:10.3399/bjgp19X702473

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We need a clear vision for primary care
Sarah C. Evans

Published on: 12 May 2019
Consultation length matters
Crispin A H Fisher

Published on: 12 May 2019
Consultation length, why are we not changing? Inertia or income protection
Nicholas Sharvill

Published on: 01 May 2019

Published on: (12 May 2019)
Page navigation anchor for We need a clear vision for primary care
We need a clear vision for primary care
Sarah C. Evans, Locum GP working in urgent treatment centre, Herts Urgent Care
Euan Lawson¹ argues that we could lengthen our consultation times. Changing surgery times would destabilise practices already on the knife-edge. Our partnership model developed in the 1960s and was still working well in the 1980s. Then, maybe we did see or speak to around 30 people a day, now suggested as a safe limit by the recent PULSE workload study.²

Young doctors won’t commit to joining partnerships, where the capitation model compels doctors to process 40-60 appointments per day with a further punishing hundred or so clinical decisions to be made in letters,...
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Euan Lawson¹ argues that we could lengthen our consultation times. Changing surgery times would destabilise practices already on the knife-edge. Our partnership model developed in the 1960s and was still working well in the 1980s. Then, maybe we did see or speak to around 30 people a day, now suggested as a safe limit by the recent PULSE workload study.²

Young doctors won’t commit to joining partnerships, where the capitation model compels doctors to process 40-60 appointments per day with a further punishing hundred or so clinical decisions to be made in letters, messages or results. Yet senior GPs can’t let go of it, with cost-rent, CCG money and out of hours businesses paying their school fees and their pensions.

There is a danger that vested interest is holding us back. General practice is evidently broken, yet we flounder, debating continuity and telephone triage. We need a firm, shared, vision for primary care which includes what a reasonable workload is, safe for us and for patients.

We need to be part of an organisation large enough not just to employ a multitude of colleagues: sub-specialist GPs; specialist nurses; extended role practitioners; diagnostic physiotherapists; call-handlers; pharmacologists (and more) but also to train us. It will research and implement the structures able to assign the right person for each task. Our future organisations will be large enough to mesh without of hours services. Appointments will be accessible. Our reformed service will re-gain first world cancer outcomes and reverse deteriorating life expectancy.

Taking primary care into the future requires the College to rise above the vested interests of its officers. It needs to set standards for doctors in primary care which may not be achievable in partnerships existing today. With this model behind us, and a clear College ruling on what is a safe workload for one doctor in one day, we could confidently take to the streets. Ending ten minute consultations with a new approach to primary care will enable us to offer something approaching excellence once again.

References

1. Lawson E. Debrief: Consultation length matters. Br J Gen Pract 2019; 69 (682): 241. DOI: https://doi.org/10.3399/bjgp19X702473.

2. Pulse. Workload survey: “We are working beyond the safe level”. www.pulsetoday.co.uk/news/hot-topics/pulses-gp-workload-survey/workload-survey-we-are-working-beyond-the-safe-level/20038667.article (accessed 10 May 2019).

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Competing Interests: None declared.
Published on: (12 May 2019)
Page navigation anchor for Consultation length matters
Consultation length matters
Crispin A H Fisher, GP, The Marches Surgery, Leominster, Herefordshire
Euan Lawson is right to draw our attention to the length of the GP consultation in the UK. Reference to martyrdom is not required. GPs and their practices have it within their gift to make the changes required to move from 10 to 15 minute consultations. We have recently done so at our own practice, and it would be fair to say that it has been the single most beneficial change in my 21 years at the practice. There has been a reduction in GP stress and anxiety (running late suits no-one), morale has improved correspondingly, and...
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Euan Lawson is right to draw our attention to the length of the GP consultation in the UK. Reference to martyrdom is not required. GPs and their practices have it within their gift to make the changes required to move from 10 to 15 minute consultations. We have recently done so at our own practice, and it would be fair to say that it has been the single most beneficial change in my 21 years at the practice. There has been a reduction in GP stress and anxiety (running late suits no-one), morale has improved correspondingly, and patients are now given more time for their problems. We calculated that we would lose about 70 GP appointments across the week to achieve the change. In preparation for the move, these have been more than replaced by employment of nurse practitioners, a paramedic, a musculoskeletal FCP, and most recently, a mental health nurse FCP.

Many practices are moving to 15 minute appointments, and we would urge others to plan to so do. We may even find it adds a few more precious years to GP careers.

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Competing Interests: None declared.
Published on: (1 May 2019)
Page navigation anchor for Consultation length, why are we not changing? Inertia or income protection
Consultation length, why are we not changing? Inertia or income protection
Nicholas Sharvill, Locum/portfolio GP, Kent
I have experience of working as a locum in both 10 and 15 minute systems and as an appraiser of practices where they have changed.

Put it perhaps a little simply one obstacle is that other staff may need to be employed to deal with repeats and Docman to free Dr time. This may reduce income in the NHS GP system. without a reduction in the working day. Bizarrely increasing quality and probably reducing prescriptions and referrals may also cost the GP income.

Competing Interests: None declared.