Euan Lawson argues that we could lengthen our consultation times.1 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 that 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 with out-of-hours services. Appointments will be accessible. Our reformed service will regain 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 that 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 10-minute consultations with a new approach to primary care will enable us to offer something approaching excellence once again.
- © British Journal of General Practice 2019
