Health

'Patients at risk' from length of GP consultations

GP handing out prescription Image copyright Science Photo Library

Patients are being put at risk by GPs being forced to carry out complex consultations in 10 minutes or under, the British Medical Association says.

The doctors' union said patient care was undermined when GPs were forced to see as many as 60 patients a day.

It called for more funding to allow GPs to spend at least 15 minutes with each patient.

NHS England said consultation lengths were up to doctors and there were no national limits suggesting 10 minutes.

However, the NHS Choices website does state that "GPs spend an average of 8-10 minutes with each patient" and advises patients to "plan ahead to make sure you cover everything you want to discuss".

The BMA, which published a report on "safe working in general practice" earlier this month, called for a reorganisation and warned that GPs faced "unsustainable pressure" from increasing workload and staff shortages.

The report said it was intended to "stimulate discussion" and put forward a model that could be used across the UK.


'Unsafe levels'

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Dr Nicola Hulme, a GP in Cheshire, said she found NHS England's comment about there being no national limit on appointment times "insulting".

"With the high levels of demand, we have to run 10-minute appointments," she said.

"To offer longer with the same number of appointments would extend our day to beyond the 12 hours we currently routinely work.

"I often run late so I can deal thoroughly with my patients' issues.

"Paperwork gets started routinely after 7pm. I rarely get home before 8pm, having started generally at 7.30am.

"Nobody goes into medicine for an easy ride, we are all hard workers, but the intensity and the demand are now at unsafe levels."

Dr Ali Alibhai, who works in central London, said GPs now had to manage so many chronic diseases such as diabetes that a consultation as short as eight minutes was "not appropriate any more for safe patient care".


Dr Brian Balmer, of the BMA's GPs' committee, said that, in an ageing population, many patients had complex multiple conditions that needed longer to treat.

He warned that many GPs were being forced to truncate care and deliver an "unsafe number of consultations".

'New approach'

He said consultations should be limited to 25 a day, about the same number recommended in many other EU countries.

Dr Balmer added: "We need a new approach that shakes up the way patients get their care from their local GP practice.

"The consultation time needs to increase to 15 minutes with the government providing on its promised funding to make this work."

Health think tank the King's Fund said its analysis showed GPs were under "huge pressure due to an increase in workload which has not been matched by a growth in funding or the workforce".

It also found the average length of consultations had increased due to the rising number of older patients with more complex conditions.

King's Fund chief executive Chris Ham said general practice needed "new investment to stop it falling apart", but GPs must also embrace new methods such as giving more advice by phone and email.

NHS England said the length of appointments was "at the discretion of individual GP practices, based on patient need, and there are no national limits suggesting 10 minutes should be the norm".

It accepted that GPs were "under pressure", and said it was "substantially increasing investment and reforming care to free up GPs to spend more time with patients".

In 2013, a rule saying GP appointment slots in England must be for a minimum of 10 minutes was scrapped.

'I would be dead'

One patient, John White, from Somerset, said: "I think those who get a 10-minute consultation with their GPs are lucky.

"At my doctors' surgery I cannot even book an appointment to see my GP. All we are offered is to book a 'telephone triage consultation' where your doctor will call you by telephone and decide whether a face-to-face appointment is warranted.

"I have had to wait in excess of two weeks for the telephone appointment."

Another patient, Maggy Jackson, said: "I have a brilliant GP who sees me for as long as I need. He always runs on time too.

"All I can say is if it wasn't for this practice I would be dead. They diagnosed a gangrenous hernia two years ago when I presented with horrendous pain and no appointment. I was given a full examination, morphine and was in hospital an hour later after their intervention."

Nurse Liz Wright said appointment length was also an issue in nursing.

"In years gone by, I had either 15 or 20-minute appointments to see my patients," she said.

"This has now been cut to 10 minutes, in which to carry out triage, cervical smears, dressings, injections, contraceptive discussions and issuing of prescriptions and a whole range of ailments.

"This means that in a typical 7.5-hour shift, I see up to 42 patients, well above the recommended daily amount.

"In my opinion this is unsafe practice and I have decided to take early retirement."

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