GP appointments should be five minutes longer, says BMA | Society | The Guardian
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Depends on so much that...

No, we don't necessarily need longer appointments. We need more doctors and more resources. There's only a certain amount of time in a working day so longer appointments also means fewer appointments, which means longer waits.

In my own practice, I ran an audit because my duty days were much more busy than when I first started here. In five years, there has been an increase of 50% in consultations but the practice population has stayed the same. Given that GPs get paid by list size (ie number of patients registered), there has been no increase in funding to compensate for the increased workload.

On the other hand, if the average appointment takes 5 minutes longer than the time currently alloted, then it makes sense to make fewer appointments for each doctor.

If I make an appointment with a customer for 10:00, I see him at 10:00, unless I get stuck in traffic. But at the doctor's, if you have an appointment for 10:00, it isn't unusual for you to have to sit around for 30 - 40 minutes, before you see them. Surely if we know that we can't see the patients in the alloted time, it doesn't make sense to pack the waitingroom full of disgruntled patients having to wait 40 minutes beyond their appointment time? Why not allot more time to each patient and keep the waiting room less full and the waiting time shorter. That makes for happier patients and less wasted time.

Obviously, if patients are trying to make more appointments than time available, then more doctors are needed. But keeping patients waiting under false pretences (why ask them to come in for a 10:00 appointment, if you know you can't see them until 10:30 or 11:00?) isn't good for anybody.

That said, I went to the hospital for the post-op check-up and got there 10 minutes early, I left the hospital again 7 minutes after my appointment time.

Any idea why? That's the key question to fixing the problem.

I think there's several issues here. I tend to run to time around 90% of the time. When I'm behind, it because:

- a patient's turned up late and so the appointment runs late. I can't kick a patient out after 7 minutes because they were 3 mins late
- a patient's problem is more serious and requires more time eg spending time trying to get the patient admitted to hospital
- something has come up unexpected eg urgent phone call from consultant worried about a patient
- a patient's brought in more than one problem to discuss. The patient might think they're three "quick" things but they almost always turn out to be three things that take a minimum of ten mins each

I gather the reasons why appointments were created in general practice were to minimise waiting. Patients would rock up at the door at opening time, queue to be seen and would wait until their turn. Because some patients were waiting for hours, they'd want to go away and come back later. Hence introduction of appointment systems. My childhood GP operated an open surgery. You sat and waited in a queue to be seen and could easily wait for three hours to be seen. But you were guaranteed to be seen.


That would require analysing every appointment with the GP. Given that it's something like 15,000 a year at the moment, that's a lot of analysis to be done. Sometimes patient's see us because of coughs/colds (ie wanting antibiotics). Sometimes it's for a genuine problem. Sometimes it's for something the hospital has "asked" us to do. Sometimes it's for chronic disease management eg diabetes.

My morning list of patients came with the following problems:

• depression follow up
• diabetes disease management
• mole check
• back pain
• diabetes disease management
• knee pain, awaiting surgery
• knee pain despite having surgery; rash on legs
• flare of asthma, wants antibiotics for "chest infection", wants creams for rash on body
• keeps falling over*
• young kid with back pain for twelve months
• ear blocked with wax
• urine infection
• review of patient with prostate cancer

* probably the only one who would benefit from a longer appointment.