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GPs in catch-22 over appointment length and rising demand

GP consultations are among the shortest in Europe and too short for complex cases

Louise Prime

Tuesday, 07 February 2017

GPs are caught in a catch-22 situation between a spiralling demand for the number of appointments they provide and the need to make appointments longer to deal with increasingly complex patient needs, the Royal College of GPs warned this morning.

The BBC has been looking during its own ‘NHS Health Check’ this week at GP consultation length. It reported that doctors’ leaders believe consultations are already too short, and that additional workload, as even more services are set to be pushed out of hospitals and into the community, will destabilise care.

The UK’s standard 10-minute consultations are among the shortest in Europe, recent research has confirmed. College chair Professor Helen Stokes-Lampard told BBC Radio 4’s Today programme this morning that this works perfectly well for simple, straightforward conditions, but she went on: “For the vast majority of people that GPs see – those with complex medical problems, those who have several conditions at once, who are on multiple drugs, and possibly those who have mental health conditions overlaying all that – then 10 minutes is clearly completely inadequate in this day and age. Fifteen or 20 minutes is more appropriate and more in line with what happens in the rest of the world.”

In response to comments that practices could simply choose to set different-length appointments, as 10 minutes is not mandated by government, she said practices had to balance the need for longer consultations with the opposing need to manage rising demand for the number of appointments. She pointed out that GPs are “ridiculously overworked”, with too few of them to cope with the 15% rise in patient consultations since 2010, and the situation is “on the brink” with surgeries currently closing all around the country.

She said: “GPs would love to offer longer appointments (and sometimes we do where we recognise there’s going to be a problem) but because we’re firefighting the whole time just to get through the number of patients that need to be seen we’re in a bit of a catch-22 situation.”

The College said the GP Forward View, which promises 5,000 extra GPs and £2.4bn more per year for the profession by 2020, is a “lifeline” – but these pledges must be implemented urgently, as well as being mirrored in Scotland, Wales and Northern Ireland.

Professor Stokes-Lampard warned: “As it stands in England, there are two Sustainability and Transformation Plans that actually propose reducing the GP workforce, there are five that don’t mention the GP Forward View at all – and there are many others where the plans for general practice are vague at best. This is against all common sense – the future of our health service relies on high quality, robust general practice to underpin the rest of the NHS and provide care efficiently in the community.

“We need more GPs, more practice staff and more resources for general practice right across the UK so that we can offer our patients more appointments, and longer appointments to those who need them.”

The College has rejected suggestions that people should be charged for missing appointments – an idea supported by the public, according to a recent Ipsos Mori poll for the BBC – on the grounds that it would not be cost-effective, would disproportionately affect those already struggling, and would go against one of the fundamental principles of the NHS that care should be free at the point of need. It said other ways of reducing missed appointments, such as sending people email and text remainders of their appointments, were already having positive effects.

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