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Gold, incentives and meh

GPs have ‘chosen’ 10-minute consultations, claims NHS England lead

Practices are continuing to work in 10-minute appointment slots when they should be varying appointment length, NHS England’s head of general practice development has said.

Dr Robert Varnam also told delegates at the RCGP’s Annual Conference last week that the policy of practices restricting patients to one condition per consultation is 'unethical'. 

He was speaking after RCGP chair Professor Helen Stokes-Lampard appealed for GPs to have time to give the holistic care that patients increasingly need in her opening speech of the conference in Liverpool

Dr Varnam said: ‘I think we have chosen to work in 10-minute appointment slots when some people could be dealt with in five, and others couldn’t be dealt with in under 20.'

He likened these restrictions to the policy of practices asking patients not to bring multiple conditions to discuss at their appointment - which has been criticised by commissioners and in the national media. 

Dr Varnam added: 'I just think it’s bad medicine to force someone to say “no you can only talk about one”. I think it’s unethical, I think it’s uncaring, and I think it’s counter-productive.

‘Because while it’s understandable to do that under pressure – “because I’m protecting myself” - that person goes back to reception, books another appointment and you start from scratch again.’

But GP leaders have said Dr Varnam’s comments were ‘unhelpful’ as practices are best placed to know how to meet their patients’ needs, as well as being contractually entitled to do so.

Doncaster LMC medical secretary Dr Dean Eggitt accepted there were pros and cons to the 10-minute model, but fundamentally GPs were only able to give the service they were funded for.

He told Pulse: ‘What’s more unethical is if we turn a load of sick people away with nowhere else to go.

‘We’re stuck in this situation where we either give a substandard consultation in 10 minutes, or a brilliant consultation - taking however long the patient needs - and losing the opportunity cost of helping more people.’

The RCGP has campaigned for half-hour appointments to be the norm, while Professor Stokes-Lampard has repeatedly said NHS England’s pledged investment and workforce commitments must be delivered so that appointments can be longer and access improved.

GP leaders negotiating a new Scottish GP contract have said they expect it to be the end of restrictive 10-minute consultations.

Readers' comments (46)

  • I tend to agree with most of my irate colleagues.
    I think this is an excellent example of the extent which, those nominally running the health service, no longer even pretend to have any semblance of contact with reality.
    This is not an important article ,it is the important article of the year
    We should be grateful for a clear, and mercifully succinct,statement of intent from God
    This article needs to be shown to every medical student,then they should be given the rest of the week off, to think about it.
    There can be no more effective means of ending the health service,nor a more rapid one

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  • Agree with all of the above comments.
    I don’t think it is any coincidence that this comes off the back of JH’s speech at conference suggesting that GP’s can and should sort out their own problems - now the NHSE stooges are being wheeled out to reinforce the rhetoric that we aren’t helping ourselves.
    Meanwhile, back in the real world, patient expectations (and need?) are unmanageable.

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  • Vinci Ho

    For the record, it is essential to have the correct writings on the wall. I advise more colleagues speak out on this.

    Today's news is tomorrow's history. Repeatedly,we have seen history being twisted and betrayed by those trumiumphants in games of power . And their subordinates are never tired in uploading more lies and ideologies.
    What is the truth and reality? At least , it is not like what they described as the cause(s) of a failing system , diverting responsibilities to those working very hard in the frontline to ,at least ,keep the system sustaining.
    Those who talked about controversy are the persons of controversy. And they are the ones who have been hypnotising our conscience and as a result, we cannot look at the conscience of the world.
    Just looked the calendar this morning and realised that history has almost passed 100 years from the Red October Revolution of Russia in October 1917(November by western calendar). That was one of the hallmarks (alongside with the First World War) which set the beginning of an eventful 20th century with vigorous and ideological upheavals where so many innocent lives were disadvantaged and perished meaninglessly. Of course , there is a spilling over to this day in 21st century............

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  • Vinci Ho

    Correction
    .....triumphants....

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  • I have decided to limit my working day to 12 hours. Take off 2 hours for paperwork bloods etc leave 10 hours or 600 minutes . Peak work is 112 patient contacts or 5 minutes 21 seconds each. My feelings about the article are pre moderated so please just imagine

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  • Many GPs have contracts stating min appts/week. Given payment for this is minimal there are little opportunities to offer longer slots. Trying to make this a moral issue is particularly offensive.

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  • “NHS England’s head of general practice development”........great.
    I find these comments (as reported) insulting to those of us trying to do the best we can for increasing numbers of patients with increasingly complex medical problems. There has to be a compromise between availabilty and length of appointment. I do not consider it to be “bad medicine” to concentrate on the most important/urgent problem and continue the consultation (not “start from scratch”) at a later date and in a single/double/triple appointment when necessary. Routine 1/2 hour appoinmtents would waste so much time, much of it probably taken by patients complaining how long they had been waiting to be seen.

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  • Vinci Ho

    You see
    Never look back after labelling NHSE as Ministry of Plenty ( and the rest).
    Recently on this platform, we seem to have some sympathisers(including one of our respectable, young , female columnists) commenting that people actually working very hard in NSHE to improve NHS and general practice which I could understand.
    Problem is always coming from the leaders instead. Well ,this public statement from NHSE is phenomenal and perhaps should remind sympathisers the need of eyes wide open.
    An enemy is an enemy, remains an enemy.....

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  • It must be quite hypoxic from the rarefied atmosphere at the top of the greasy pole so far removed from the reality of daily working to appear to be as obtuse as this.

    Chapeau.

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