In the pre-GMS 2 contract world, 5-minute appointments were common, and the standardisation of appointments at a minimum of 10 minutes was a relative step forward. Under the New Labour government, the push towards Advanced Access approaches saw the return of short appointments, but in endless addition to the scheduled morning surgery appointments of 10 minutes apiece. But like motorways, opening new lanes can sometimes just generate more traffic.
Is the solution more appointments or better appointments?
Do we need to differentiate appointment length of acute care from simple chronic care (ie one condition) and complex co-morbid care?
Do we need to use different staff groups with different appointment lengths for different categories of care?
The situation in Sussex
We’ve recently carried out a study (April 2021) on the length of GP appointments through the 3 Sussex CCGs: Brighton and Hove, East Sussex, West Sussex.
Our research found that out of the 169 practices we’ve analysed, about 20% of the practices in Sussex are leading the way by offering longer appointment times and about 80% are applying 10 minute-slot appointment systems (whether on the phone or face to face).
20% of the practices in Sussex are leading the way by offering longer appointment times
Most of the longer appointment times were for 15-minute face-to-face appointments with the exception of a couple of practices carrying out 20-minute appointment times. Some would also apply intermediate lengths, such as 12, 13 or 14 minutes.
On the lower end, some practices were carrying out 5-minute triage calls by their GPs. And these calls could be followed by 10-minute face to face appointments.
The data must be taken with caution this year because of the volatile situation related to the pandemic. Some of the practices have extended the face to face time slots of GPs (to 15 or in some cases 20 minutes) to account for the time necessary to clean the room between each patient. This could mean that when we are back to the “new normal” some might decrease their appointment times again. It will be interesting to see how these figures have evolved by the beginning of 2022.
Is it possible to do a good job in 10 minutes?
Helen Salisbury, a GP Partner teaching medical student at Oxford University and St Anne’s College, says that “it’s probably time to quit the pretence that we can do a good job in a very short time, especially considering that the average number of problems discussed in each GP consultation is 2.5. If we timetable 10-minute appointments we can fit lots of them in, at least on the screen—but it means that patients are kept waiting, and stressed doctors work through their lunch break.” In her experience, the average time per consultation is about 16 minutes, “which means that she usually runs late”
A recent report by the Royal College of General Practitioners suggested that all appointments should be at least 15 minutes long. Professor Helen Stokes-Lampard, chair of the Royal College of GPs, said: “It is abundantly clear that the standard 10-minute appointment is unfit for purpose.”
She continues “’Without more resources and an expanded workforce, longer consultations would simply mean increased waiting times, undermining patients’ ability to access the care that they need.”
For Helen Salisbury “In a brave new world of multidisciplinary teams, some patients will consult nurses and physician associates instead, but in our experience these staffs are even harder to find than GPs.”
You can see our separate discussion on the value of creating multidisciplinary teams in our article here.
If you increase appointment times, you then need more staff in order to maintain the same number of appointments. More staff cost more money, so to pay for them you need to either make more money or take less profits.
But are all the appointments necessary? Practices that have instituted coffee mornings for so-called “frequent flier” patients have found that social isolation is a key element, and that addressing this can significantly reduce the demand from some patient groups.
And what of the complex co-morbid patients? The RCGP talks about 15-minute appointments, but in private and European settings half an hour would still be considered short. Should we be reserving GP capacity for complex case management (perhaps three/five or more conditions) and using more AHP staff to deal with acute/single chronic condition care?
It is always a fine balance for independent contractors, between profitability for partners, and having enough employed clinical staff to make the job both achievable, and enjoyable.
If GP jobs as well as the other clinical roles (paramedic, physician associates, ANPs, etc) are made more achievable and fulfilling then the roles are undoubtedly more attractive. Future models of care must ensure that burnout is reduced in all staffing groups, and that the work-life balance desired by so many coming into the sector is achievable.
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