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GPs buried under trusts' workload dump

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 know where you are, Dr Varnam. You're down in the Ministry of Truth, altering the headlines. For I'm old enough to remember 10-minute appointments being IMPOSED on us, and it sticks firmly in my mind because at the time I worked in a practice which had a long and successful tradition of walk-in surgeries. It was only a choice in the sense of, "Do you want to be paid and be allowed to remain open, or don't you?"

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  • This is such an emotive issue simply because this is all about control... over our lives. Will workload be dictated by the "specialists" from ivory towers, or will we be able to have any say.
    Thanks RCGP, another stab in the back.
    Shamefully had to join in order to play the game and get training practice approval. Cancelling membership on Monday.
    No winners here. Will they ever learn to listen to the grassroots? Doubt it. Massively inflated sense of self-importance will always stand in the way.

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  • He's not the RCGP.

    You can choose an appointment system that gives more flexibility but to do this you need proper funding and a full complement of staff.

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  • He is not. But he follows HSL laments about loneliness and holistic care... do you not get a sense that you're just never going to be good enough? That customer might just need more of your time?
    And plenty of other reasons to cancel RCGP membership any day.

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  • Rubbish, GPs dont choose to have 10 minute appointments, they are forced to because of the way we are paid, and the unlimited demand.
    Our useless union needs to immediately change our contract. If we spend as long as required to see all our patients properly, do all the possibly required tests and then refer or treat as needed, but CHARGE NHSE for all the time involved, then the problem will become theirs.
    It is our contract which is wrong.

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  • As a single handed GP I have never seen the point of restricting patients to a single problem. Why should I? they will only book in to see me tomorrow.
    Single problem consultations are a game playing strategy that GPs use where there is a high probability that another GP will see the patient when they rebook. Although it goes against the grain I have to agree with Dr Varnam, it is a disrespectful practice.

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  • Has 'Dr' Varnham ever worked as a real Doctor?

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  • This comment has been moderated

  • as usual NHSE and DOH blame GPs for the problems, and expect us to fix it ourselves. Offer huge long appointments, deal with every problem in everybody's life (boiler checks anyone?) and make sure we give unprecedented access to everybody under the sun all at the same time.

    how about for once the powers that be take responsibility and ownership and actually HELP rather than disparage us and we might get along a little better.

    can't wait to emigrate and finally take control of my working life.

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  • Sorry Gary
    I have to respectfully disagree, but appreciate your contrary point of view. I respect my patients time and hence aim to run on time.... I see the same patients back myself, I do not palm them onto other doctors....... we work step wise through the problems in small bites which keeps the confusion down, especially if there is a lot of information to impart, and means that I get too see the patient on a number of conditions, and interestingly how the symptoms vary episode to episode. It also often raises symptoms or other issues that the patient forgot at the first appointment. You say not listening to all the problems at one go is disrespectful.... funny, I was always told that keeping others waiting is disrespectful. I havent had a single complaint from the patients about multiple single appointments, and actually because I am seeing them more frequently, like any other skill, small amounts regularly and often is a better way to learn about a patient than intermittent long drawn out consultations where you are under pressure as the clock ticks by. Different doctors will use different styles that work for them, but it would be interesting to see the data from different consultation styles on patient outcomes and adverse incidents/ significant events. All the research from other industries shows that interruption or trying to do too much in to little time results in error.

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  • UNETICAL to make such comments. patient can spend one hour discussing their problems.
    patient who is seriously ill and you are arranging ambulance and they ask about a rash and repeat script and ask you to discuss the list they brought.
    I am happy to tell them get your priority right. when you come out of hospital we can sort others problems out.

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