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Ten-minute consultations 'must go', says NHS England director

The age of 10-minute GP appointments ‘has got to go’, as the limit is ‘unsafe’, a senior director of NHS England has said.

Speaking at the main debate rounding up the Pulse Live conference in London today, Dr Mike Bewick, NHS England’s deputy medical director, said this must ‘undoubtedly’ happen.

However GPC chair Dr Chaand Nagpaul said GPs could not lengthen consulations without reducing patient access to appointments.

Responding to a question from the floor, Dr Bewick said: ‘I think the age of the ten-minute appointment has got to go, undoubtedly. As a commissioner, I think it is unsafe as well.’

‘I think you have got to manage what comes in through the door as well, at least make an attempt to put something in that stops people getting through in cases where self care would have been more appropriate.’

‘I think that requires training, as an issue for practices, not necessarily for individual GPs, and probably a training issue for larger providers of general practice.’

The BMA voted in favour of abolishing the 10-minute appointment at its annual representative meeting in Edinburgh last year, declaring it a thing of the past, and GPC chair Dr Nagpaul, who was also on the Pulse Live panel, said: ‘Ten minutes is a total insult to so many of our patients… I would like to offer 15-20 minute appointments but if I do that I would have to tell them that they have to wait two weeks to see me.’

Questions from the floor also focused on reducing expectations and demand on GPs from patients, to which Dr Nagpaul responded that he would like to see schools educating children what to expect from GPs, as well as how to manage a cold.

He said:‘Demand management and self-care is very important – educating patients and the public about how to use a limited resource effectively and responsibly. I think children in school should be educated about the role of GPs, the role of the pharmacists, and actually how they can manage colds and sore throats themselves.’

Readers' comments (58)

  • Vinci Ho

    It is good for Kissinger to play the good guy and say what should have been said long ago.
    But where is the commitment and actual investment to make this happen ?

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  • The whole debate is meaningless, some patients need 30 mins, but others only need 2-3. We need to run flexible systems, that is the challenge

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  • Chris Kenyon

    Longer consultations will mean appointments per GP so we will need more GP's whatever (as we will need to also be on the phone keeping out things that don't need to be seen). We are constantly being told about a looming manpower crisis - large numbers of GP's retiring in the next few years but trainee places not increasing. It doesn't add up, it can't happen.

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  • Dr Mustapha Tahir

    One cap never fits all! The NHS bosses never think so!!

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  • The RCGP has been calling for longer appointments for years. Good to hear NHS England is on message. Wait a minute, though how to fit the same number of patients into the working day to maintain access
    Now where did Hermione put her "time turner"?

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  • Drachula

    Yes, I need a time turner too!
    More investment for more GPs and prescribing nurses - ours is excellent and we hate it when she is away on hols!

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  • Bob Hodges

    Give me just a little more time, and our love will surely grow!

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  • 15 minutes should be the standard we all aspire to now. We need to be brave enought to get on and just do it - it actually works really well.
    If you are still getting 2 -3 minute appointments your systems are not working - a GP should not be seeing those in 21st century - they should be elswhere or not in the system at all.

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  • I disagree, lots of practice do telephone consults lasting less then 5 mins , you can't really solve stuff in 1 appt anyway.
    Follow up appt can be done in less then 5 mins , eg blood test normal, prescrbing contracpetion etc etc
    Bp review,
    Obviously for complex problem you need longer and flexibility is key which frankly is far more important and works much better.

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  • Everybody blames the patient - absolutely wrong!!!
    It us - our tools and our expectations - professional and paymaster.
    The classical patient with single problem, GP diagnosis and advice and treatment fit nicely into 7.5 10 or 12 minutes - which ever suites you best.
    It's the agenda from behind- QoF, guidelines, check lists etc... that add to the length. The new generation of computer software is also a major consumer of valualble time - both looking for information and the burden of record keeping - both adding 3 -4 minutes before and after consultations at worst.
    Mike Bewick is absolutley correct - in this complex multiple co-morbidity world 10 minutes is no longer safe.

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  • As Geoff Schrecker (30 April 2014 6:37pm) has already commented the entire debate is meaningless as the amount of time we actually spend with the patient can vary depending on the problem.The real agenda here is to permit patients to discuss more than one problem during the consultation and to eventually penalise those GPs who refuse.This obviously has time and resource implications for us all.

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  • Balint (1950's) - 7 minute for the patient
    Pierera Grey (1996) - 40 minute per year
    Nobody seem to have explored Denis's great idea in depth - may it's time to ressurect it and be more truly hollistic and safe and sensible and effiicient and proactive..... I could go on....Our thinking is 60 years out of date....

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  • All parties will be happy if we have a contract that pays per consultation time 10 min or 20 min - patients chose depending on how many problems s/he has, doctor/ receptionist can extend 10 min to 20 min depending on complexity and then claim ( Aussie system allows that to happen). To me it sounds more fairer than current bottom less unlimited contract, I propose this to morning session at Pulse live but speakers seems to think that this is too revolutionary !!!

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  • Sounds like NHSE should put their money where their mouth is re negotiate the contract pay per consultation, even better pay by the minute time spent with the patient.You will need a lot more GPs,Youls need a hell of a lot more money.Will you get any benefit,not without controlling demand.Which planet do these people live on one with limitiless time and limitless pockets full of money!

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  • Una Coales

    Why should patients learn how to self manage minor ailments when they can pop into their GP surgery and see a GP for a free checkup, free prescription and free refills?

    Ever wonder why patients are discharged from hospital or sent out from outpatients with a hospital prescription but do not fill their prescription in the hospital pharmacy (as they would have to self pay) but instead take it to see their GP to exchange for an FP10 to get meds for free?

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  • I'm sorry, which planet is Dr Beswick on?

    You cannot train the practice staff to triage appropriate and inappropriate attendances. If you could, NHS111 would have worked. You can train clinicians to do it - there are system such as Doctor First but as any caller all get clinical contract, strictly speaking it's not reducing burden of work for practice.

    As pointed out longer appointment is a pie in the sky without funding and work force to go with it. Can we please have a realist at the helm and less of ideologist please.....

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  • I think people in the helm has few more years in the NHS (more than 80% of them will retire in less than 5 to 7 years), hence leaving this mess for all of us who has to work at least 25 years before we can think of our retirement! call me ageist, but this is the reality, we need new blood in the system who have guts to challenge age old not fit for purpose funding allocation formula.

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  • No-one, GPC, BMA or any other body should be advocating increased work-load in the present financial crisis faced by primary care. There should be no barrier at the family doctor's door-if you want this-redesign the whole service.

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  • More of everything. You know what will happen - it will be 15 minutes but 45 consultations each day or more as people get older - we could be soon seeing 50+ patients a day - almost 11 hours of consultations. Safe - what is safe ? I have done over 700 weekends starting at fri 9 am to mon 5 pm - 80 hours with little or no sleep. This NHS has never ever been safe - it has always run on doctors working to the bone. The ULTIMATE question is this - WHO should define safety ? Our union ? Like pilots and bus drivers ?
    Remember and like it or not - it was the European WTD that regulated junior hours. Left to our so called Union they would still be doing 120 + hours / week as a lot of us oldie goldies have done. Who will define safety in patient numbers seen and consultation times. If not us, Why NOT ?

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  • Una Coales

    Being a NHS GP partner is like a double edged sword. You are self employed so exempt from the EWTD of 40 hours but at the same time employed by govt and subject to unilateral variation of the contract with a trade union whose hands are tied up in legal knots and rules. The only way out is individual or en masse resignation from a contract that will either drive you to an early grave or bankrupt you.

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