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Guest editorial: It's about time...

Guest editor Dr Michelle Drage argues that GPs must act to resist red tape and regulation and deliver longer appointments for patients.

Guest editor Dr Michelle Drage argues that GPs must act to resist red tape and regulation and deliver longer appointments for patients.

So health minister Mike O'Brien says he doesnt want PCTs to make drastic budget cuts after all. But we will have to see how that translates in the real world, where hospital trusts are exploiting PCTs' lack of will and expertise to manage secondary care contracts properly. It will be far easier for them to go for the soft target of general practice, scapegoat us and cut trainer and trainee payments.

The report by KPMG for NHS Hillingdon demonstrates a complete lack of understanding of how to get the best from GPs, with practices under pressure for displaying the very skills that are supposed to be the epitome of practice-based commissioning. But it doesn't stop with PBC, with demands for yet more performance management and financial straitjacketing to make GPs conform to the NHS corporate agenda.

Moreover, the burden of bureaucracy is now interfering with our consultations, reducing the proportion of real patient contact to no more than half the allocated 10 minutes – leaving GPs now unable to make sufficient eye contact with their patients.

It is amazing, then, that we GPs still manage to deliver a service that is the envy of the world. Or do we? Professor Steve Field, the highly respected chair of the RCGP, says consultation lengths of 15-20 minutes are needed. This week's survey findings on the increasing complexity of consultations suggest he is right. Ten minutes is an insult to ourselves and to our patients. So how do we lengthen consultations when everything is working against it? Smaller lists? With practice funding falling in real terms, how can we do that? More GPs? Newly trained GPs are crying out for partnership jobs, but how do we create them?

The feature on managing red tape is a welcome tool, but it is sad we have had to create it. So much of our energy is spent colluding with the inadequacies of the NHS. Yet with revalidation looming, we cannot afford to be judged in an environment that prevents us from doing our job. We need to act before it is too late. There is no regulation that defines how long a consultation should last. The piece on taking control of our consultations shows us where to start. The survey findings should serve as a clarion call to our leaders, the Government and the public that health is already suffering from a severe lack of consultation time. They can start by stripping out poor PCTs and expensive management consultants. And we must go for longer appointments, and do the job properly.

Dr Michelle Drage is joint chief executive of Londonwide LMCs and a GP in Shepherd's Bush

Guest editor Dr Michelle Drage Guest editor Dr Michelle Drage Guest editor

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