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Letter of the Week: GPs were frozen out over appointment cuts

NHS London seems to be making our worst nightmares come true (‘BMA call to arms over GP appointment time cuts',

Ten years ago I was staying with an GP friend working in Colorado, US, when his HMO sent him a letter saying he would have to increase his productivity by 10% by seeing patients more quickly. I glibly remarked this could never happen in the UK!

The proposal is crass for all the reasons you make in your excellent editorial. What were once shorter consultations are now phone calls or nurse appointments, leaving more complex consultations that require more time. Reduce the length of these and GPs will have insufficient time to sort out problems and will simply refer or prescribe more.

If this really was McKinsey's idea (and why doesn't the NHS start saving money by getting rid of management consultants?) then it has failed to examine the evidence that exists on consultation time. This shows patients given a shorter consultation time (five as opposed to 10 minutes) have fewer problems identified and are less satisfied with the consultation. They are more likely to return within four weeks with a new illness and consult more often. Finally, they are less likely to be given preventive care and more likely to be given a prescription. All these have major negative economic consequences.

The proposal is symptomatic of a terrible disconnect in high places between clinicians and managers. Senior managerial leadership in the NHS has systematically neutralised clinical leadership and failed to listen, understand or relate to primary care. Now, in hard economic times, we are paying the price. It cannot work because ordering independent contractors to do things they believe to be wrong will only get boxes ticked but never affect outcomes.

The answer is for central management to start enacting the rhetoric of localism, clinical engagement and clinical leadership (not simply saying it) before it is all too late for our health service. The NHS Alliance has been involved with discussions about this, but progress is far too slow.

Dr Michael Dixon
NHS Alliance chair and GP in Cullompton, Devon

Proposals to cut consultation times by 33% are a sign of the disconnect between managers and GPs, argues Dr Michael Dixon