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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)

  • As a prescribing nurse practitioner I have 20 mins; it's safer and productive; the patients deserve it. Maximise our potential either on the phone or face to face.

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  • Una Coales for GPC chair. Much sense spoken. I've left general practice now and could not face the prospect of going back just to be used and abused as everyone's doormat (patients, DOH, Daily Wail etc). It's a shame for a lot of the patients I used to enjoy seeing and helping. I've turned to the dark side of the force now and work 7 sessions as a permanent ED doctor. It's actually very rewarding and the way GP land is at the moment, I can't see me going back anytime soon.

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  • Dear Anthony, can anyone do 7 sessions of Erectile Dysfunction and stay sane?

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  • Una Coales

    @Anthony I am so glad to hear you made your exit in time. Yesterday I learned that a GP partner dear to me committed suicide in his early 50s. His family and mother are heartbroken. IMO the NHS contract killed him.

    Please GP partners out there, it is time for en masse resignation from this untenable and unworkable NHS contract that will either force you out through bankruptcy, burnout, ill health or God forbid suicide.

    We have our very own never event among us. It is time to demand a ballot to walk out of this nightmarish NHS contract and demand better working conditions, better pay and literally, demand a life-line!

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  • I am saddened to read about GP's committing suicide. surely a clear sign that the stresses of the job are more than is sustainable. GP's working all day to see 45 patients made me smile... just a little.

    A typical fracture clinic workload for me in some hospitals is 200 patients to be seen in the morning session, followed by 150 in the afternoon session. The NHS has always run on unpaid overtime. If the multiple layers of micromanagement were removed, the costs could be diverted to staffing the service with clinically useful staff.

    I had occasion to be hospitalised in the Netherlands. The GP charged for her services and the hospital she provided emergency care from within, billed me for her time and service. The hospital billed me for its services and I paid for them and recovered a proportion from my travel insurance.

    What struck me most about the hospital was that it was clean and well staffed and I assume that was because it was not competing with any other healthcare services providing institution for a very small slice of a total pot, subject to the whim of our political masters.

    My arrival post cardiac event in the Netherlands was to be told that my GP could see me for an URGENT appointment just three weeks after my arrival back in the UK. Clearly there is a workload/priority issue at my assigned multiple partner GP practice.

    I guess GP's need more help from HM Government. I really would not like to see the efforts of GP's squandered on propping up a system which no longer caters to the sick. Our treat the well culture, based upon nonsense research, has turned everyone into a patient. Please, GP's stop treating the worried well and go back to working with the clinically unwell.

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  • 07 May 2014 0:03am has pretty much summed up why the NHS is in a mess - 'turned everyone into a patient'

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  • Dear Jeff (0.03am), thanks for the comments, much appreciated.
    As you state, GPs often see upwards of 45 patients a day (and necessarily including home visits). Whilst it no way matches your staggering patient count of 350 patients a day, I would like to point out few facts.

    GP appointments are currently 10 minutes. Most of us agree this is no longer sufficient to deal with increasingly complex and multiple co-morbid patients we deal with, but that's by the by. According to your patient count you would by working 58.33hours a day to see all those fracture clinic patient of yours working on the principle of 10 minute appointments. Now clearly that would leave very little time for err.. life, but my point is without pointing out exactly what you do with the patients you see your figures don't really mean much. Do you answer the phone and book 350 patients every day, at a rate of one patient every 90 seconds? That would work out as 8.75hours working- a conventional working day. Do you plaster fractures every 2minutes? that would workout as 11.67hrs working day. Definitely full on, almost chicken farm factory level efficiency- but I wonder how much time that leaves you to provide holistic care and know the patients you see. Maybe that's not what your jobs about so is of no concern to your situation.

    As a GP I can see a parent brought in by a son or daughter worried about dementia in appointment, a woman in an abusive relationship but afraid to leave with the kids the next, followed by a patient with angina, hypertension, COPD and diabetes - all uncontrolled and the patient not seeing why he needs to take the medications even though he continues to make appointments because he feels so unwell. Or mum with baby who cries all night and is inconsolable, another with a toddler with a rash/temp/unwell/limp/fussy eater/too short - take your pick. Or a pregnant woman with abdominal pain and/or vaginal bleeding in her first trimester. All supposedly to be done in 10 minutes.

    Yes there are a few sick (sorry....fit) notes patients for the recurring depression/low back pain/work stress and morning after pills, routine BP checks and medication reviews to lighten the load, but on the whole 10 minutes does not even come close to the time that needs to be spent on the majority of patients to make a positive difference to their health.

    So I am glad that the 45 patients a day GPs up and down the country see on a daily basis made you smile - if even just a little.

    Now imagine a time when we aren't there for you to smile at. What will you do then?


    Disillusioned GP Partner (1yr)

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  • 2 points
    the ten minute appointment in my world does not exist, I end up dealing with what I am given in the time it takes to an extent. I get it wrong, I am the one to go to court) It does impinge then in the time one has at lunch time that is supossed to be admin, but suddenly there is also home visits. For a salaried doctor it just means working for free the admin time(not suistainable, no wonder so many are locums). Longer appointments at least will recognise part of this time.
    It is curious how in other professions there is real concern about the safety of long hours and overtime but when it comes to the people that everyday are making decisions that can mean late, wrong diagnosis , death it is conviniently forgotten.
    2- I think the system is bonkers. I am not a partner as I view it as becoming a slave of the nhs. There is no business in the private sector that would sign up to delivering things that are not paid for or not having clear indications as what exactly they are going to have to deliver. I think the time of a fix fee per patient whatever the work they generate should be scrapped. Pay by work delivered. This could even be for salaried GP's (giving them an incentive for seeing extra patients)maybe adopt a system where they are also self employed.

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