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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 am totally shocked, appalled and concerned by the comments of Dr Varnam. They simply make NO sense in front line jobbing general practice.
    If this is how the Chief of General Practice in NHSE views things, how else are others in his position looking down on NHS general practice?

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  • Hi Macdonalds
    There is a nice paper on what patients consult on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750725/
    Which has some interesting findings - namely a mean number of problems of 2.6 with a quarter of consultations being for 4 or more problems. This finding was not related to this specific study, as it quotes many other studies from across the globe where it has been found that GPs universally see multiple problems.
    It seems that the consultations where only one problem was raised were mostly for acute problems.
    Interesting.

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  • Wow, Varnam some achievement, even more hated than the utterly odious 'prof' Field, major respect my man, I am sure a wonderful career awaits (just avoid dark alleys)

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  • I think Dr Varnam may have misunderstood the problem.

    GPs are not complaining that they are obliged to offer exactly 10 minutes - no more, no less - to each patient.

    The are complaining because the AVERAGE consultation time needs to be more than 10 minutes.

    Flexible appointment lengths does nothing to address this (without unacceptable knock-on effects on access)

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  • I have recently worked in 3 practices where patients are offered consultations of any length IN MULTIPLES OF 10 MINUTES (except flu-jab day, when no other services are available, and they get about 3.3minutes each).
    Patients CHOOSE how long, based on how many conditions THEY want to discuss. If patient CHOOSES only ONE condition, that is NOT my fault, and does NOT make me 'unethical'.
    It makes the patient who tries to rush us into dealing with 4 conditions in insufficient time a bully, a risk to themselves, and a liability unfairly to us.
    This 'senior doctor' might do better to improve patient education than to make disreputable criticisms of hard-working, caring, ethical, professionals.
    Has anyone reported him to the GMC yet?

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  • Having worked in NHS management roles it is safe to say a telephone call is never less than 30 mins in the diary, most meetings are over an hour and will be followed by further meetings to follow up on the issues raised in the previous one. This does allow adequate time to deal with things and resolve them, we need to be realistic about how long things take. Clinical consultation length cant be the hours in the day divided by the open ended number of people wanting to speak to you if we expect the consultations to be effective. Lengthening the consultations may reduce the consultation rate and improve quality! We are not working in a factory on a production line with predictable work, trying to pretend we are is unhelpful.

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