10-minute GP consultations are a ‘disaster’, says RCGP vice chair

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’.



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Why GP locums should join a chambers

There are many benefits to being part of a chambers if you are a locum GP, but what can you do if there is no chambers in your local area? Dr Richard Fieldhouse provides some advice.

The concept of GP locum chambers was first pioneered by the National Association of Sessional GPs (NASGP) in 2002. Chambers are generally small locally-owned and run collectives of self-employed freelance GPs, working together as a team with mutual professional support and a shared group identity to support local practices.

Outside of a chambers, working as a regular freelance GP locum can be a thoroughly isolating affair; you have to work out how to go about booking sessions, deal with issues related to working in struggling practices, and manage last-minute session cancellations on your own. You also may not have colleagues readily available to offload about a vexatious complaint you’ve had or work through case reviews for your next appraisal.

So working as part of a locum team, with support on-tap for any issues relating to locuming, and meeting regularly with colleagues who all share a similar professional identity, can lead to a greater sense of belonging. This is where being part of a chambers can make all the difference to a happy and fruitful career as a GP.

According to a 2016 NASGP poll, over 90% of members of GP chambers agree that the main reason they’re still a GP at all is because of the chambers. In fact, over half of members say they’re living where they live because of the support the chambers gives them.

How do locum chambers work?

Locums within chambers remain self-employed and able to contribute to the NHS pension scheme. The practice pays the full session fee direct to the locum, who then pays the chambers a management fee. This fee is anywhere between 3% for NASGP’s LocumDeck chambers and up to 15% of the original session fee for some traditionally-run chambers, depending on its staffing costs and the level of support provided.

It is important to realise that chambers are not agencies. In contrast, agencies are seen as employers and locum work via agencies cannot be pensioned on the NHS scheme. The agency typically retains around 30% of the fee they charge practices, paying the locum around 70%.

Some newer practice-facing online platforms sidestep being defined as agencies, allowing the locum to remain as self-employed, and undercut traditional agencies by typically charging the practice 15% of the locum’s session fee.

Benefits of chambers

In areas where agencies and online platforms are dominant, a chamber could therefore financially benefit both practices and locums. Even if the locum charges a session fee that reflects their chambers’ management fee, this is still likely to be cheaper for the practice than using an agency or a practice-facing online platform. Furthermore, the full fee is being fed back into the local health economy by paying the locum and investing into the chambers’ running costs.

Locum GP chambers also offer a unique opportunity to retain GPs in the workforce. They are ideal if you are a recently-retired partner wanting to retain elements of teamwork and equally necessary for newly-qualified GPs, allowing them a support structure that was so important during their training years.

Chambers also allow GPs the potential to ‘collectivise’ and work under the protection of terms and conditions that are designed to protect safe working boundaries. This is key in an environment of rising complexity, workload, risk and litigation.

Ironically, as the need for GP cover rises, there has been a growth of commercial companies seeking to place GPs in practices, but often under terms that are not under the control of the GP locum. Chambers can be an antidote, offering a locally professionally-led umbrella for flexible GPs.

Joining a chambers

If being part of a locum chambers is something that appeals, a good option would be to join an existing one local to you – a quick Google search should find you your nearest. If there isn’t a chambers in your area then there are two choices: either to ask an existing chambers network to help set one up in your area, or set one up yourself.


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