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Longer GP appointments 'highly cost effective', finds major study

Offering half-hour GP appointments to people with lots of health problems helps prevent their health from deteriorating at value for money that is better than many new drugs and devices provided on the NHS, a groundbreaking study by GP researchers has shown.

The study at GP practices in Scotland saw GPs give patients with complex health needs appointments that lasted half an hour or longer.

Patients who received the longer consultations had better scores for wellbeing and quality of life after one year than similar patients who received usual care from their GP with 10-minute appointments.

Although the approach cost practices more, the benefit to patients meant the longer appointments were of greater value than many drugs and interventions introduced to the NHS under NICE cost-effectiveness thresholds, researchers said.

They added that if longer appointments were being measured by the same standards as a drug or piece of equipment, 'there would be no argument about whether the NHS should be doing it'. 

The study included 152 patients with multimorbidity – mainly patients in their early 50s with five chronic conditions each – at eight GP practices, four of which were randomly assigned to undertake the ‘CARE Plus’ intervention while the other four practices continued with usual care with standard appointments.

Under CARE Plus, practices provided patients with structure 30-45 minute consultations, during which the GP dealt with all the patient’s issues, agreed care plans and goals and arranged follow-up appointments.

Results at one year showed that patients receiving the longer consultations under CARE Plus had a reduction in ‘negative wellbeing’ and higher scores for quality of life on validated questionnaires.

CARE Plus cost £929 more per patient than the standard GP services – including the cost of training staff and locum cover. However, the cost of £12,224 per ‘quality adjusted life year’ (QALY) gained was well within the £20,000 per QALY used by NICE to decide whether new interventions should be adopted by the NHS.

The researchers concluded: ‘Enabling practices in deprived areas to provide longer and more patient-centred care for multimorbid patients may protect quality of life in a cost-effective way.’

Co-author of the study Professor Graham Watt, professor of general practice and primary care at the University of Glasgow, said the study showed that longer appointments helped patients ‘not so much because they got better, but because the patients who didn’t receive the extra time got worse'.

He added: 'The intervention was highly cost effective, according to conventional NHS criteria.'

Professor Watt told the Herald Scotland: ‘It shows that if primary care isn’t well resourced and up to speed then things are just going to fall apart and patients will turn up in accident and emergency faster than they need to.

‘To everyone’s surprise and delight it proved to be cost effective. If this was a drug or a bit of equipment it would just sail in – there would be no argument about whether the NHS should be doing it.’

Dr Andrew Green, chair of the GPC clinical and prescribing subcommitteee, said: 'We already know that longer consultations are better clinically, it’s good to be told that they are better financially too.'

Dr Green added that 'having a defined safe number of consultations per GP, each of a safe length, is an essential part of GPC proposals to manage workload and enable GPs to provide high quality care without damage to our own health'.

BMC Medicine 2016; available online 22 June

Readers' comments (7)

  • I can only say that the nurse appointed in my previous practice had a very good impact on patient care. She had longer appointment depending upon the number of co-morbidities to be addressed. More like on stop shop. It saved time and money especially for the GP. It helped the patients to avoid coming repeatedly. However, GPs could not do this. Holistic approach - in 10 min is a dream! Simultaneously, simple problems don't need more time. How and who has to balance this? any advise from the study?

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  • Interesting study. So that means safer more economical general practice but longer waiting times unless extra noctors etc etc.
    I am happy to see 20 patients a day for 30 minutes. But who is going to do the visits the paperwork etc etc.
    Mr Hunt will inevitably dismiss this study.

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  • please define 'noctor' proud & passionate nurse here not a mini medic - & as article suggests I would like to see longer appointments too.. nurses & medics Bring back the joy to general practice!

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  • David Banner

    Longer appointments + no funding = longer wait for appointment = more A&E attendances.
    With fewer doctors seeing more and more patients the concept of longer appointments will never fly.

    "I can never get an appointment" is a familiar refrain from patients (whose very presence in your room contradicts that statement), yet they complain that 10 minutes is too short. Reminds me of the one about 2 guys moaning in a restaurant....

    #1- "We waited 3 weeks for a table, and the food here is terrible".
    #2- "yes, and such small portions......"

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  • Sounds like a sound basis for us working to rule. So closed lists and fewer, longer appointments. Well done chaps.

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  • Tessa Bowater

    Better clinically and better financially so how can this be achieved?. As someone who fits the criteria - multimorbid, six chronic conditions, complex health needs - this would be very beneficial.
    Currently, before each fortnightly GP appointment, I have to decided which condition is the one that needs to be addressed. Which one is causing the most concern.
    And yes, this means things are missed and with six conditions it can take three months to address them (one condition per fortnight).

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  • Of course. Shame study like this has to be done in the first place.

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