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GPs buried under trusts' workload dump

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)

  • You can't have longer consults without more resources!
    This is a joke.
    10 minutes isn't a 'limit', it never has been, just some sort of spurious guideline to enable appointment lists to be conveniently constructed.
    If everyone in my practice got a 15 min appointment, we would be fully booked by five past 8.
    I would then have to instruct my receptionists to divert more and more patients to a/e and the local walk in centre - which I would be happy to do!
    Patients need what they need, whether it's 2 minutes or 30 minutes, you just have to let them get on with it.
    Those with unmanageable lists of problems can be asked to rebook and I will do the rest next time.
    This is just more madness from more idiots who are not GPs.

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  • I would love to be instructed by NHSE to offer 15 minute consultations as a routine as long as there is a genuine assessment of the resources required.
    Please remember that, within a partnership, there are different agendas. Those that are happy to fire fight and do the minimum to increase their own income and those who are prepared to give patients longer and earn less.
    The iniquity in the system is that the more you give, the less you earn. This needs to be addressed.

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  • Just because that thinker without a thought norman lamb moans that he can't get all his agenda into 10 mins we have to offer 20 mins . People have problems getting appointments as it is . Double the workforce or go private .

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  • 10min appointments are unsafe - thats the question - so what is the answer ? And please dont make it 'working smarter'.

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  • Una Coales

    @9:01 the answer is to address demand. Start charging £10 a GP appointment to reduce demand. And start charging £100 for an A&E visit as Ireland does to stop overflow to A&E. And if left wing socialists chant that the public deserve free medical care at point of access, you chant right back that GPs deserve fair working conditions and fair pay, we are not gonna take it anymore!

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  • I'm not usually the first one to pipe up with conspiracy theories but doesn't all this look suspicious!
    ...Suddenly patients are allowed to book any length of appointment they want with no corresponding reduction in access targets.

    This would mean that GP surgeries would have to provide more appointments assuming several patients do book the longer ones (i.e. open longer to provide the same access).

    This could easily mean that smaller practices are in breach of contract and forced to close and larger ones have to employ more doctors (not a financially viable prospect) or work into the weekends and further late evenings.

    I would advise that we do not engage in this discussion without the removal of current access targets.

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  • Una Coales - just so nice to hear someone speak out. But there is a clique in there that stops the majority view. I know, I have been there.
    GP list size has to go. It is outdated. It used to be 20 appointments at 5 minutes in the whole day, followed by interminal on call.
    Now it is 40+ at 10 minutes on an upward spiral to 50+ 15 minutes and so on.
    ICS gives us some freedom, but list sizes do not reflect workloads.
    If we retain NHS ICS status, bad as it is, we have to go to a numbered appointment system. Or we resign.
    Our take home pay [ worked out by my accountant ] is now, on average, £ 3.00 here in NI.
    It is time to resign. The Eire model is readymade and easy to copy.
    GPC, please ballot. If we stay in the NHS, at least it the majority and not the GPC decision.

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  • £ 3.00 per consult that is at 60 % consults and 40% paperwork.
    40 consults x 3 = 120 . + 80 for paper work per day = £ 200
    200 x 22 days per month = 4400 per month x 12 months = 52000 x 2 [ tax, NIC etc ] = £ 104000 a year.
    In NI we don't even get that, it is about 84000.
    In reality, we do not even make £ 3.00 per consult.

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  • Interestingly here in Ireland the government (who are even more anti-doctor/GP as they are in the UK!) are trying to force us to sign a contract for free care at the point of delivery for all under 6 children which is unsignable and potentially ruinous for most practices and they don't believe us when we tell them that we will be overwhelmed with demand for appointments despite plenty of evidence from the UK that demand is hard to manage when there is no disincentive to attend your GP. Why not when it is totally free.
    Personally I would be in favour of everyone paying a small fee for each visit (around the £10 or €20 mark) which for those genuinely in hardship could be claimed back through the social welfare system, but politically it's a non-starter it seems.

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  • Although there are many merits to charging.What I imagine would happen is that there would be many exemptions and then this would undermine the system very quickly.

    Charging could work but it would have to be an absolute rule no exceptions

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  • Why charge patients for GP appointments when they have already paid via NHI deducted from their wages!
    Instead, why not charge those who DNA. We had 97 last month in a 5,000 patient practice. If this was applied throughout the country, there would be no need to even consider charging patients to see their gp which I re-iterate, is NOT free. We are all paying for the service.

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  • Una Coales

    @1:56 you have a point. The Australian health minister is announcing today that they cannot afford free health care on the current scale (Medicaid/Medicare).

    @2 pm yes I would also support charging for DNAs but that would again mean a change to the NHS contract to allow charging patients.

    The bottom line is the way things are going, there will be no GPs for the NHS and the only ones who stick around will be private GPs charging full price for consultations.

    With a semi private system, the poor and elderly get reimbursed by the state, so this cuts down on trivial visits, and thus reduces demand as it is UNSUSTAINABLE currently.

    Yes I can see some try to abuse the free medicaid/medicare system but without some provision for the poor and elderly, we would not be a modern society?

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  • The unemployed/unemployable classes should be entitled to emergency health care only

    Those who are paying taxes should have a choice if they want to go private or opt into a National Health Insurance Scheme.Either way the insurance payments should be tax deductable

    The retired ex-taxpayers who opted in the NHS during their working years can continue with free health care (+/- co-payment) provision.Those who opted to go private must pay if they decide to swap over to the NHS in their old age.

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  • Anonymous | Practice nurse | 01 May 2014 2:04pm

    Do you send appointment reminders? If you have the patients mobile phone number you can send an SMS reminder which can be extremely effective in reducing DNA's.

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  • Surely patients should get the time they need, giving them ten minutes now only to have them return in a couple of days with the same problem is pointless.
    In the time it takes to triage patients by phone, they could have been seen at the surgery anyway. If triage takes tow or five or ten minutes, that is the time the doctor has had to spend with that patient so surely a face to face appointment costs no more time and allows the GP to do a visual examination ... which should be the first part of any examination.
    Rather than stipulate times, why not allow the GP to decide what is right for each patient, after all, he /s he knows the patient better than anyone?

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  • Just Your Average Joe

    I never believed in a fee paying NHS - but am slowly seeing where Una Coales is coming from.

    10 pound a visit to GP and 100 for A&E to prevent overflow from demand is the straw that will break the NHS philosophy forever. Unfortunately thanks to Tony Blair and successive governments and the Mail stoking up expectation and demand - the flood gates of access are open.

    Without closing access requirement - so cough/colds and sore throats are left to develop beyond the <24hrs that patients now seem to wait before they ring to get appointments, the workload is unmanageable.

    If you don't charge everyone fairly - then those who get subsidised would still flood the system with demand for minor self resolving ailments or to get the free script of OTC medication, because they can and will demand the right to do so.

    We don't have to charge patients - we could simply announce to the DOH a unilateral variance in our contract - we now will bill them 10 pounds an appointment and 75 for a home visit, and let them have a national DOH advertising campaign to reduce demand - let the government fix their own mess.

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  • Stop paying A&E for seeing minor ailments.

    No money no incentive to see patients. Just like minor injury units no longer see under 2's, major trauma and MIs, the patient is seen where they are meant to go.

    Hospitals will just have signs up saying this is an A&E, we don't see anyone who hasn't been in an accident and is not a major emergency. If they still turn up then see them and charge them 100 pounds.

    The waiting rooms will be empty in a month.

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  • well well we never thought 10 minutes was long enough..what a genius! so lets do 20 mins on average instead..oh hang on when do we do repeats scrip requests hospital letters referrals check results..oh of course lets do it through the night..between seeing patients 24 hours with urgencies of convenience...gps dont need sleep.
    well dr bewick i would like you to pilot this......

    talk about stating the cannot happen though like so many other pieces of obvious motherhood and apple pie.
    the only solution is more gps.
    end of.
    (plus a cull of 90 per cent per cent of the nhs 'management' structure....more useful retraining as gps)

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  • I find this really annoying. We run an open access service to our patients - busy but patients love it.

    On a Monday I can see about 45 patients - at 15 mins each - that is nearly 11 hours of surgery alone in the day!!!

    Some patients simply need a sick note (you might argue it will give you time to discuss issues) or a virus or a pill check (should be nurses!)

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  • @3.12 am - please go and get some sleep. Your alarm will go off in 3 hours!

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