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Independents' Day

GPs should provide longer appointments, says CMO-backed report

An expert review has advised the Department of Health to ensure GPs have enough time to discuss the benefits and risks of drugs they prescribe to patients.

The Academy of Medical Sciences, which carried out the review on behalf of the Chief Medical Officer for England, found that a current average 9.2-minute GP appointment ‘does not give sufficient time for conversations about treatment options guided by evidence-based decision aids, or about the patient’s goals and priorities’.

The experts found that only around a third of patients (37%) trust scientific research, compared with 67% who trust the experience of friends and family.

They also noted that even GPs find it hard to trust scientific research, with 82% agreeing that clinical trials funded by pharmaceutical firms were often biased to generate a positive outcome.

In response, the experts call for improvements to research as well as greater patient involvement both in scientific research and in decision-making about their own treatment.

The report says: 'To support joint decision-making between healthcare professionals and patients, we recommend that... general practices ensure that enough time is available through care planning and that adequate resourcing is provided by commissioners of primary care services to address patients’ priorities and concerns regarding medication decisions.'

CMO Dame Sally Davies wrote to the academy to request an expert review back in 2015, following a string of negative press surrounding the risks of medicines, most notably statins – which other studies have shown led to people stopping their medication, putting them at increased risk of cardiovascular events. 

Their recommendations (see box) are based on surveys of more than 1,000 GPs, as well as input from members of the public and evidence from researchers, charities and other experts.

Professor Sir John Tooke, who led the expert review oversight group, said: 'We do think more GP consultation time will be needed to deal with these important issues but we also suggest measures to optimise the use of time including a care planning approach, the adoption of ‘goal orientated medicine’ that prioritises issues of most importance to patients, and the provision of questions that enable patients to get the most out of their consultation.

'Decision aids and, in the future, more sophisticated algorithms may also help, without removing the crucial interface of the skilled clinician.'

Dame Sally added that it was 'vital that we find the best-possible ways to use and communicate scientific evidence, so that progress may be translated into benefits for patients'.

The RCGP, which has campaigned for longer GP appointments, welcomed the recommendations but pointed out they could not be delivered without adequate funding for general practice.

College chair Professor Helen Stokes-Lampard said: 'GPs are delivering care to over one million patients every day, within the constraints of the standard 10-minute consultation, which is increasingly unfit for purpose and does not lend itself to the type of in-depth conversations necessary to explain what are often complicated health matters.

‘We want to spend more time with our patients, but offering longer appointments means offering fewer appointments, and due to the intense resource and workforce pressures currently facing general practice, our patients are already waiting longer than they should be for routine appointments.’

The BMA's GP Committee's prescribing lead Dr Andrew Green said many complex patients would require 20-minute appointments.

But he added: ‘The inevitable consequence of doubling appointment length would be halving appointment frequency, and no government has yet had the courage to put aside the simplistic access agenda to allow us to put quality first.’

The full recommendations

  • Involve patients, carers and the public in research;
  • Address gaps in training in research methods and statistics;
  • Enhance the recognition of robust research findings;
  • Ensure best use is made of new sources of evidence;
  • Enhance dissemination of research findings;
  • Develop frameworks for declaring and managing interests;
  • Develop best practice guidelines for academia-industry relationships;
  • Improve the content of patient information leaflets;
  • Position NHS Choices as a central repository of information on the benefits and harms of medicines;
  • Improve the reporting of scientific evidence in the media;
  • Support joint decision-making between healthcare professionals and patients;
  • Continuing dialogue and engagement with patients and the public.

Source: Enhancing the use of scientific evidence to judge the potential benefits and harms of medicines

Readers' comments (17)

  • Recommendations like these do not contain any consideration of context. And as such they have as much meaning and relevance as Alice in Wonderland.

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  • If we increase the gp appointment time from 10 to 15 mins, it will be positively received by patients initially. When the qaiting times increase by another 30% in the coming weeks, the backlash and wrath will also be faced by Primary Care. So, hey, if there is no funding to employ ample staff, just forget it. DoH is good at lip service and RCGP and has bad habit of seconding everything that comes from DoH. This time, however, they do agree that without resources you can't do much.

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  • The government will simply reply by stating 'it's down to GPs to decide how long their appointments are'. Waste of time and money

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  • Vinci Ho

    Thank you for telling me my mother is a woman!
    But as I always said time is one of the four components of resources (alongside with money , manpower and expertise; one for all , all for one). The reality is something DoH is too cowardice to face.....

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  • So then, fewer appointments overall. Unless you just mean adding 50% to the length of each surgery.
    O, you do mean that........

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  • Back in the day when my mother was a GP (in the 1950s and 1960s) she never had a problem with patients getting appointments - because she didn't have any. All patients turned up on a sit-and-wait basis. There more I read of the problems caused by rigid appointment systems the more I wonder whether a return to such a system would be beneficial. Folk self-prioritise; if they decide the wait will be too long they will go away if it's not that urgent.

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  • Andrew Bamji there is a lot to be said for that some single handers did that round here until recently and it worked well.

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  • Healthy Cynic

    Thank god for experts! Otherwise how on earth would we know that we don't have enough time to do the job properly?

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  • Working people find it difficult to "sit and wait" for a routine follow up appointment. They are simply too busy. Secondly, demand has increased dramatically since that era so open appointments could potentially be never ending, running hours after the door closes; and that doesn't include the admin left to do after face to face appointments are finished.

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  • David Banner

    Re Andrew Bamji

    As stated above, the reason we all abandoned "sit & wait" in the '90s was massive increase in demand. I did 30, 40, sometimes 50 patient surgeries Monday mornings, totally unsustainable.

    As for increasing appointment times with falling numbers of GPs, total fantasy land. Not gonna happen.

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