Speaking at Londonwide LMCs’ conference on Wednesday, Professor Martin Marshall said: ‘The 10-minute consultation is a disaster, essentially. I’m not sure it was ever adequate, but it certainly isn’t adequate now when we know consultation rates are going up and the complexity of what we’re dealing with is going up as well.’
He said that GPs should be focused on triage and complex health problems, which offered an ‘exciting career choice’ for junior doctors.
‘There are essentially two things GPs are really good at. One of them is triage – we’re really good at making quick decisions about whether someone is ill or they’re not ill, what they need, what they don’t need. The other job is dealing with complex problems which involve at least 20-minute, probably 30-minute consultations, like they have in Sweden or Denmark,’ Professor Marshall said.
10-minute model
‘The stuff we don’t need to put our efforts into is the stuff in the middle – probably the 60% of stuff in the middle – the 10-minute consultations for relatively simple, relatively straightforward things.’
He said this model was proving very popular with younger doctors, but ‘slightly less popular with older doctors’.
‘When I say this to junior doctors they really buy into it,’ Dr Marshall said. ‘If you want to do the triage stuff or the complex stuff that’s a really exciting career choice – depending on your own inclination you can choose what proportion of each you want to do.’
‘But we need to find a way of not doing the stuff in the middle,’ he added. ‘And that way needs to be more systematic and faster at delivering than it is at the minute.’
Complex patients
Both the BMA and RCGP have said repeatedly that 10-minute consultations are inadequate in the face of rising demand and complexity of patients,
Earlier this year research published in the British Journal of General Practice found that patients with multimorbidity account for around 53% of GP appointments in patients over 18.
Research published in BMJ Open last year linked shorter consultations with lower quality care and found an association between shorter consultations and physician burnout.
The BMA’s 2016 report Safe Working in General Practice said that introducing 15-minute appointments ‘would allow improved decision making and case management, and should reduce the administrative burden outside clinic times’.
Credit: GPOnline