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GPs buried under trusts' workload dump

Sorry, I won’t go south at this time of day

Copperfield

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So there I was in the taxi when I had a ‘Eureka’ moment: I saw the future of general practice.

Not the one foreseen by the RCGP in its recent document, I should add. I was reading this simply to give myself an excuse to stare fixedly at my phone, rather than engage with the driver in Brexit-banter.

And what I read was that the ivory-tower masterplan is 15 minute appointments by the year 2030. Yawn. Cue, quite correctly, the statement-of-the-bleedin’-obvious that we can have 15 minute appointments now, if we want. The obvious downside being that, if patients want 1.5x as long with the doctor, there will only be 2/3 the current number of slots, so they will have to wait 1.5x as long for an appointment. And 1.5x a long time is quite possibly never, which might not be a bad plan, given the powerful political point it would make.

Autolink siphoning money from the patient’s account using some Hancockian hi-tech wizardry

But I don’t actually want 15 minutes per patient if it implies that each appointment is going to be a multimorbidity, polypharmaceutical moan-fest. I like the odd quickie to spice things up, but they don’t take 15 minutes, do they? So perhaps, instead, we need something novel and nuanced. Such as length of appointment being proportional to wait. Insist on seeing me today and you’ll get one minute. But if you’re prepared to hang on six months, well, you can have a whole day consulting on a chaise longue plus an intimate examination of your choice.

At this point in my musing, the taxi ride came to an end. I looked at the meter, and that was when I had by lightbulb moment. It was staring me in the face. Of course! After all, the ten minute appointment would be fine if patients actually stuck to ten minutes. And if we can’t have an actual trap door opening when time’s up, we need a metaphorical one. A meter! A charge for every minute they go over their allocated slot: a penalty of £5 per minute, escalating to £10 per minute after 15 minutes. That would soon put a stop to ill-focused rambling, requests for repeats, ‘while I’m here’s and so on.

I’d suggest we have the meter prominently displayed in the consulting room and beamed through to the reception area as a warning to other punters, with an autolink siphoning money from the patient’s account using some Hancockian hi-tech wizardry. And for any patients reading this: no refunds for quickies.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield

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Readers' comments (10)

  • National Hopeless Service

    In my training practice in the 1980s one of the partners did have a large hour glass sand timer. As soon as the patient sat down he would turn it over and it was used without fail. He would literally stop the consultation when the last grain of sand fell. I have heard of GPs of old not having seats in their consulting rooms and the best one being the GP had cut a few inches off the front legs of the patients chair so that had to sit at an awkward and uncomfortable angle.

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  • This time will come to pass.

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  • David Banner

    I used to set my phone’s stopwatch to 10 minutes, ending in the sound of a duck, then state “the quack says it’s time to go”. It worked well, but the mound of complaint letters on the P Manager’s desk convinced me to reluctantly cease and desist.

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  • Cobblers

    I had a ten minute desk 'bubble' toy which wasn't often used but if Mr or Mrs Heartsink came in, you know the ones, with the pink glasses, multi coloured hair, one or two crutches often mismatched, who would sigh several times before starting with the "I won't keep you long doctor", then I would pick up the toy and invert it in front of them.

    Once it ran out I would stop the consult. It did trigger protestations but rarely complaints. Some never came back, result, and others just came more often.

    :-(

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  • A brilliant article that gets right to the most critical issue we face. Heartily agree with everything you say. Patients often worry about trivia and giving it 10 mins attention is encouraging dependency. !0 mins are fine for my generation of GPs if there is a mix of long and short cases.

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  • I echo Jonathan Heatley - brilliant article - I agree with every word!

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  • Insightful and witty.
    Also reminds me of the (presumably apocryphal) story about the patients’ chair with shorter front legs and a shiny seat.
    And another (presumably apocryphal) story about ‘focus’.

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  • Dear All,
    Just like the noblest of professions, including "quickies".
    Good idea.
    Regards
    Paul C

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  • Or what about ..... A chess clock. Pts have 2 hrs preloaded annually. Click at start and end of consultation. Once time up - gotta re-register. Most will never get close , a select band will be 3 strikes and out !

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  • I have had a different lightbulb moment. Why offer appointment times at all? All it does is tie you to inflexibility. If you let them all sit and wait, first come, first served, any doctor will do, then the heartsinks will be balanced by the quickies. That's how it was back in the 1950s and 60s when my mother was a GP. Those who didn't really need to be there soon realised that turning up too often was simply wasting their time.

    Only joking. Or am I?

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