‘Unfit for purpose’

The length of GP appointments must be extended to support patients with increasingly complex health needs, doctors have said.

The call comes at a time when the average GP appointment is just over 9 minutes as family doctors struggle under the yoke of massive GP and nurse shortages, coupled with funding cuts to the NHS and other services.

Five years ago, GP appointments were set at 10 minutes, but this was dropped from April 2014. The average GP appointment is still about 10 minutes, but this week the Royal College of GPs (RCGP) said that by 2030, this should be lengthened to 15 minutes. At the moment, the UK has one of the shortest GP appointments among developed countries

RCGP chair Professor Helen Stokes-Lampard called 10-minute appointments ‘unfit for purpose’.

“It’s increasingly rare for a patient to present with a just single health condition, and we cannot deal with this adequately in 10 minutes,” she said.

“GPs want to deliver truly holistic care to our patients, considering all the physical, psychological and social factors potentially impacting on their health. But this depends on us having more time to spend with patients, and the resources and people to allow us to do this.”

Doctors have emphasised that extending the length of GP appointments now will be all but impossible against a backdrop of insufficient resources and a shrinking workforce.

The RCGP has estimated in a new report that realising its vision for the next decade, which includes longer GP appointments, will require general practice to receive at least 11 per cent of the NHS budget in all four nations of the UK.

The GP workforce must also expand by thousands, as must the wider practice team workforce. The College has also called for GP specialty training to be extended to at least four years to expose trainees to the full spectrum of increasingly complex and chronic health conditions.

Doctors in Unite (DiU) chair, Jackie Applebee, noted the pressures GPs are now under as health conditions have become more complex.

“Chronic disease management, such as diabetes, ischaemic heart disease, asthma, chronic obstructive pulmonary disease and hypertension used to be the preserve of the General Physician in the hospitals when I first became a GP in the early 1990s,” she explained.

“But this care is now mainly done in General Practice. We also look after people with complex mental health problems as services are cut and more and more people have nowhere to go except their GP.”

Her experience bears out in figures, which have shown how the work GPs do has become more complex over time – the number of people with multiple chronic conditions increased by 8 per cent every year between 2003 and 2016. Now, half of all GP appointments deal with patients with long-term health conditions.

Where Applebee practices, the standard GP appointment is already 15 minutes but she believes even this is not enough time. But the workforce crisis in the NHS must be tackled to extend the length of appointments successfully across the board, she said.

“Care has been relentlessly shifted from secondary to primary care without a concomitant rise in resources,” she explained. “We can’t recruit GPs or practice nurses to do the extra work. We also need a fully functioning wider primary health care team yet district nursing and health visitor posts remain vacant in large numbers.”

Applebee noted too that the social impact of austerity is adding to the pressure on GPs and cannot be ignored.

“Austerity means much harder lives for many people,” she said. “The child poverty rate in Britain, for example, is a disgrace. The stress caused by austerity finds its way to our consulting rooms.”

This was an issue UniteLive highlighted earlier this month, in an investigation that found that the impact of austerity was so bad that people are booking GP appointments to get help with issues such as housing because they have nowhere else to turn.

Added to all of these pressures, Applebee noted that since 2010, NHS funding has only increased by a mere 1 per cent, when at the very minimum a 4 per cent increase is needed to keep up with rising demand and populations increases.

“The NHS is on a precipice, kept going by the goodwill of everyone who work for it — whether in hospitals or the community,” she warned. “Fifteen minute appointments must be accompanied by robust resources, both financial and human, to relieve the stress on the system. Otherwise, the situation will only worsen – and will give the tabloid press another stick to beat GPs with about the difficulty in getting appointments.”