The flaw in proposals to cut GP consultation times by a third while also reducing referrals is so patently obvious, GPs could be forgiven for laughing the idea off. Except that the plan is deadly serious...
Last year, in her guest editorial for Pulse, Dr Michelle Drage made an impassioned plea to put longer consultation times right at the top of the priority list for general practice. Dr Drage, joint chief executive of Londonwide LMCs, argued GPs needed to offer appointments long enough to match their increasingly complex caseloads, if they were ever to reclaim control of their working lives. Her call echoed that of Professor Steve Field, chair of the RCGP, who had earlier argued for GPs to offer consultations of at least 15 minutes. And the BMA is on board too, with its election manifesto saying appointments of up to 20 minutes were desirable to help GPs manage complex cases in the community and keep patients out of hospital.
So the proposal by NHS London to slice millions from its budget by cutting the length of GP appointments by a third sounds so out on a limb, so patently absurd, that the initial reaction is one of ridicule rather than fear. Many GPs will have glanced at their calendars, wondering if it could really be April already. Others will have commended NHS London on its newly discovered sense of humour. But as the true extent of the crisis in Britain's public finances becomes clear, and edginess among health service managers turns to downright panic, proposals that would once have been regarded as comic relief will now have to be taken with deadly seriousness.
The most obvious flaw in the proposals, developed after advice from management consultancy firm McKinsey, is just how glaringly internally inconsistent they are. NHS London wants to bring down GP appointment times by 33%, yet in the next breath declares its intention to reduce numbers of patients going to A&E by 60% and to hospital outpatients by 55%. Just where does it expect all these patients to go? Academics, doctors and even politicians are united in arguing that we need to strengthen the ability of primary care to manage patients with complex needs if we are ever to reduce their flow to hospital. Under the NHS London proposals, GPs would have time to do little more than introduce themselves and fill in the referral form. Shorter consultations equal rising hospital attendance and increased, not decreased, costs.
Of course, there are serious questions about whether NHS London could ever actually implement its plans. GPs remain in charge of their appointment times, and although PCTs could impose contractual requirements for practices to offer many more appointments per day, any such attempt would be vigorously opposed. But the fact that the proposals have been made at all indicates just who has the ear of NHS managers, as they attempt to balance the books. Not doctors' leaders, certainly, who will be absolutely united against these plans. Perhaps not even the Government, which warned trusts just a few months ago to avoid ‘slash-and-burn' cuts. In difficult financial times, it is money that talks loudest, and managers are only too eager to listen.