28 July

Are we about to see the end of the 10 minute GP appointment for patients with long term chronic conditions? The results of a very interesting piece of research which was conducted in eight GP practices in Glasgow over a whole year suggests that this might be the case.

While there is no easy answer to the problems of long term healthcare, the study clearly showed that increasing a patient’s regular appointments with their GP from 10 minutes to 30-45 minutes made a radical difference to not only their condition, but also to the cost of their care for the NHS.

Four of the Glasgow practices carried on as before, while the other four provided extended appointments and follow ups. 152 patients were involved across both practices and all were over 50 years old, suffering from a range of chronic conditions that included diabetes, asthma, arthritis and chronic obstructive pulmonary disease.

Over the year, the patients with their usual appointments continued to endure declining health, while the others who had the extended consultations had a distinct drop in ‘negative well being’ and scored much higher on quality of life.

Of course, the longer appointments cost up to £929 more per patient per year than the standard GP services. However, the research showed that despite the initial cost increase, the results proved to give much better long term value to the NHS than many of the prescription drugs formerly provided.

The Glasgow researchers found that while the longer appointments cost £12,224 per patient for each extra quality year of life, this was well within the funding guidelines of NICE, which allows £30,000 for a patient’s extra quality year of a healthy life, taking into account any drugs and medical interventions that may be required.

The conclusions of this research were so promising that further studies are due to take place in Liverpool, Manchester and Bristol. In 2015 the BMA surveyed 15,000 GPs and it revealed that 90% of GPs think the current 10 minute consultation slots are inadequate for many patients and should be reviewed. It’s almost impossible to cram everything into a 10 minute consultation when you are diagnosing care for a patient with one or more chronic health problems. The BMA has called for a more flexible system to enable GPs to spend longer with the patients who have serious needs.

Of course, this may upset patients with less serious needs who still feel they are paying for the NHS and should therefore have the same level of treatment offered to everyone. For example, one 50+ health conscious patient who rarely needs to see her GP had two minor ailments. She booked an appointment, the earliest being 10 days hence and when the GP finished on the first issue the patient started to explain the second. She was firmly told by the GP that she could only deal with one medical issue per appointment, unless told in advance, and the woman would have to book another appointment. Perhaps the answer will eventually be to go back to a time when a patient had as long as they needed with their GP but for that to happen the NHS needs to put vastly increased funding into Primary Care and encourage more doctors into general practice.

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