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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)

  • Let's take him at his word and switch to 15 minute appointments en masse.

    He will not like the result.

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  • Prefer to take (on this occasion) Prof HSL's advice and go for half-hour appointments.

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  • What’s unethical is climbing up the greasy pole of being in a leadership role like head of NHSE General Practice development or RCGP chair and making repeated unsupporting and morale sapping remarks to grassroots GPs who are busting a gut in keeping this under funded out of date system going for their patients.

    Use your time to improve the awful system we work in for the improvement of patients and our health and stop being a government mouthpiece and puppet.

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  • Cobblers

    Most practices I have worked in, including my own when it was open, run a 10min basic appointment with an extended 20 min appointment if requested by patient or thought needed. If patient takes 5 mins then bonus.

    Just love it when Ivory Towers merchants tell us the way to do it when they would wet their britches if put in the pressure cooker environment that it NHS General Practice nowadays.

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  • National Hopeless Service

    Dear Dr Varman,

    This is what your new best friend Jeremy Hunt had to say at the RCGP conference;

    We have to recognise that too many GPs are knackered, feel often at the end of their tether. They feel they are on a hamster wheel of 10-minute appointments, 30 to 40 every day, don’t feel able to care like to give to patients.

    And so many GPs are talking to me about the problems of burnout. In the end, there’s a mismatch between the work we are asking GPs to do and the number of GPs we have to do that work and that is the root cause of that burnout, and we absolutely need to address that.

    The truth is, because we have underinvested in general practice over decades, we have made it much harder for you to deliver continuity of care.

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  • Dear All,
    I think i can claim to be the source of the "one appointment, one patient, one problem" concept from when i wrote our first local charter and self help guide, way back in the 1980s. It was adopted by the LMCs of South London and has spread. The flaw in Dr Varnnams hypothesis, and its a big and difficult to avoid one, is that no one knows how long the problem is going to take before its discussed, not me, not him, not the patient, not the receptionist. If we simply spent as long as was needed for each patient as they came in then we'd run fast ahead of schedule, then run late, then fast again because of the very unpredictability of general practice. One patient's chest pain might take 5 mins whereas another's might take 20. You cannot do what he advises if you also want to have any semblance of an appointments system. The only way you can spend as long as it needs as they come through is to have a walk in, first come first served, and "you'll have to wait as long as it takes for me to get to you before your turn" system. Hmm I can see the Head of General Practice Development and other GP gurus liking that.
    The ten minute one appointment one problem one patient is not ideal but its the best compromise in the circumstances.
    We tried allowing patients to select 5, 10 or 15 mins for their appointments to see if that would work but hey guess what, patients perceptions of how long their problem would take was a world away from clinical reality.
    Paul C

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    Don't remember being asked...never mind choosing....
    NHS England is just exploitative....unfortunately goodwill is fast running out...
    So lists are ok.... add to this Qoff nags... add to this poor historians and late arrivals.... add to this appraisal reflection and logging.... add to this repeat med requests in consult........wake up.... something has to give
    Is it unethical to decline to see a relative brought in who did not have an appointment??? Signpost to available care.... Time manage to protect your sanity...

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  • Vinci Ho

    Ha ha ha
    As soon as I said NHSE could not afford to be so arrogant as like before the last general election, somebody wanted to prove me wrong. I slapped my face for this .
    There is a Chinese saying,' it is easy to change the mountain and river but the fundamental personalities of people can never be changed.'

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    Look at the programme GP's behind closed doors... they look like they've got 30 minute appts.... How about showing real general about following a locum around.... will be eye opening...

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  • It’s fine saying increase the length your appointments, but NHSE know full well we are unable to do this as we simply would not get through the day. The reason is, we can’t stop them coming. Just because I give Mrs Jones 30 minutes to talk about her IBS doesn’t stop the scores of patients who also demand its ‘their right’ to be seen that day and contractually we have to. Until these magical hubs are developed to soak up the extra work.

    Comments like Dr Varnam’s are unhelpful and counter productive to the problems we face. It’s further denigration of GPs.

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