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The waiting game

GPs criticised for treating one condition at a time

A patient watchdog has criticised GPs for displaying signs telling patients that they will only deal with one condition at a time at routine consultations.

Aneurin Bevan Community Health Council (ABCHC), which monitors health services in South Wales, said some practices are continuing either to put up signs or to tell patients verbally that they will not deal with more than one condition at a routine appointment, despite previously being warned it was ‘clinically inappropriate and indefensible’.

However, the RCGP has argued that some practices are forced to make such rules to cope with heavy workloads.

The issue was raised at an Aneurin Bevan University Health Board meeting, where the ABCHC’s new annual report was highlighted.

The report states: ’Last year we drew the Health Board’s attention to the bluntly worded signs which we had observed in some GP surgeries indicating that only one medical issue could be dealt with in a routine GP consultation. We considered that such notices could inhibit patients from raising a number of symptoms which may be linked, and could discourage a fuller discussion which might assist an accurate diagnosis.

’The Health Board agreed with this view and the assistant medical director (general practice) communicated with all GP practices in the Gwent area to advise that a blanket policy was clinically inappropriate and indefensible.’

The board said that there has been a ‘reduction in this approach’, but that ’we are still seeing it continue in some areas’

It adds: ’While appreciating the time pressures in GP consulting rooms, we are concerned about the risk to patients if this issue is not fully resolved.’

But RCGP Wales vice-chair Dr Jane Fenton-May said: ’I can see where the CHC is coming from but this is one of the things that GPs have to do to regulate their workload. Some practices have been doing this for a long time.

’If a patient comes in with a shopping list of four or five things then sometimes you just have to tell them that you’ll look at the one that’s most important. Sometimes their problems are linked but sometimes they are not. We are limited to ten minutes per consultation, but the RCGP would like that to be longer.’

Dr David Bailey, Deputy Chair of the WGPC said: ‘GPs should treat holistically, although we understand that sometimes when providing urgent rapid access it may be important to clarify that the time slot is limited.

‘We would not support a blanket rule however, as sometimes a patients different problems are inextricably linked.’

NICE is currently working on guidelines for GPs dealing with multimorbidity, which are due next year.

Readers' comments (26)

  • so is it "clinically appropriate and defensible" to mismanage or misdiagnose serious pathology because the GPs was rushing to get through 4 or more potentially complex problems in one 10 minute slot. Let's be honest... the same patients who demand to shoehorn multiple problems into 10 min appointment are the very same one who would be the first to complain if something important was missed in the rush.

    This job gets more and more stupid by the day...

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  • usual LHBs doing nothing to curb innappropriate demands or support General Practice, No wonder theres a massive recruitment problem.... Gp's arent exactly queuing to work in the Gwent valleys. Well done Aneurin Bevan

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  • Russell Thorpe

    I agree with this one it goes against everything I consider inherent in being a GP to limit what the patient brings to the consultation. So its a longer consultation the next one with that person will be shorter. Not every consultation should be shoe horned into 10 minutes you just need to ave 10 minutes over a individual surgery.
    I know this opinion will fall onto stony ground.

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  • I don't give a flying fig what this health board think I should do. When are we going to stop being micro-managed and how dare people tell me how to consult? One of the key skills of general practice is time management. Most doctors can assess and manage a problem in an hour. It's only a GP who can do this at 10 minute intervals. If you want the free for all buffet to extend to unlimited time, then give me unlimited resources. No? Thought not.

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  • Years ago one would get an even mixture of "long" and "short" consultations that would balance things out. In today's society most consultations tend to be "long" due to the increasing complexity with the ageing population as well as the higher demands of the population in general. The 10 minute appointment is therefore outdated.

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  • Ildiko Spelt

    even for1 condition 10 min is the minimum in most of the cases ...we are not "supermen/superwomen" ...who wants more can go to the ski-fi films...

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  • I agree with Russell.

    Negotiating the priorities to be addressed during the consultation is a core GP skill - in fact, it's hard to think of any more fundamental task we face.

    I have worked at surgeries with such signs and am always embarrassed by them.

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  • Every man and his dog who has never done the job thinks they can tell GPs how to do their job. Funny how this doesn't seem to be the case with other jobs or professions. Think it has a lot to do with political interference and the agenda of keeping GPs down. Major lack of respect for ten plus years of training. But that's the entitled attitude in the UK.

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  • Blanket signs are wrong. however where I am a patient they have signs saying 'the GP will deal with one problem in one appointment, however if you have multiple problems make a list and the GP will discuss whichever is most important' - this is the best way, and it's how I consult.

    when a patient says 'well there's 4 things Doc', I quickly respond with 'well tell me what they are and we'll see if we can address them', usually swiftly followed with 'well they clearly concern you, but which are you most concerned about, let's talk about that one, make another appointment for the rest but make it a double'.

    patients don't understand or appreciate that for them it takes 10 seconds to say what's wrong, but sometimes it takes 10 minutes for us to work out what's wrong (if not more), and we just can't deal with 5 or 6 complaints in one go. I had this exact example a few days ago. somebody came in with a shopping list of problems (but didn't even give me the courtesy of being up front about it, you know, the kind of ...'oh and just one more thing doc' patient), and gave 2 word histories. literally 2 words. would not elaborate at all. 'elbow pain'. 'cough'. 'tummy hurts'. it was like dealing with a 2 year old. (FYI I quickly triaged them and they were all non-urgent).

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  • I recently went to a meeting about MSK problems. The Orthopaedic Consultant stated they should have 30 minutes per new patient in the local MSK clinic for one issue but only get 8 minutes.
    It is interesting the patient groups don't mention about GPs over running and making other patients wait who have other things planned in their day. If GPs dealt with every problem in one sitting it will be quite routine to be 1 hour behind and I feel sorry for those patients who have come on time and are having to wait.
    The answer is 15 minutes per patient and see less patients and use other ways of getting access. Either hire "cheaper" ANP/PA or cut list size.

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