The appointment between a patient and a General Practitioner (GP) is the heart of general practice through which primary care is delivered. However, as we all know, appointments are time-limited bringing frustration and risk of misdiagnosis.
In this blog, I will offer some advice about how to get the best out of your 10 minutes.
Today the Quality and Outcomes Framework demands appointments last around ten minutes. Studies have shown that on average GPs spend around seven to ten minutes with each patient.
A much debated topic is whether the time GPs spend with their patients is enough. Patients sometimes feel that all of their concerns have not been addressed or they have been unable to properly describe their symptoms. They may simply be shy, and require time to have embarrassing, but diagnostically crucial, symptoms coaxed out of them.
The Deputy Medical Director for the NHS, Dr Mike Bewick, commented at the Pulse Live Conference in London in April 2014 that:
“the age of 10-minute GP appointments ‘has to go’ as the limit is ‘unsafe’.”
In general, longer appointments are associated with better health outcomes and increased patient satisfaction. However, sometimes a quick five minute appointment will give a patient all the help they need. With increasing demands on GPs, an ageing population and too few GP’s to care for patients needs, extending the length of the appointment may not always be possible or a realistic solution. GP’s must therefore ensure that the time used with patients is as efficient as possible and addresses all the patients concerns.
What to expect during your GP appointment
During an appointment, your GP should make sure that you are at ease so you feel comfortable talking about sometimes embarrassing and often very personal issues. Your GP should check that you have discussed all of your problems before you leave. If a GP decides that a patient needs to go for tests, scans or further treatment they should explain what the tests are for and when they should get the results by to make sure that the patient is fully informed. If a course of treatment is recommended, your GP should explain any other ways to treat the condition, any side effects or risks of the treatment and whether there is anything that you should stop or avoid doing. GP’s should also recommend, where applicable, support groups or where to go for further information. Your GP should remind you before you leave that you should go back to see them if you are concerned or feel that your condition is getting worse.
What can go wrong?
In my experience, common reasons for negligence claims against GP’s include:
- A failure to investigate symptoms and carry out an appropriate examination
- A failure to take into account medical history
- Failure to carry out or arrange appropriate tests
- Delay or failure to make a referral to a specialist
- Failure to set out a clear treatment plan, such as arranging for review of the patient if the symptoms persist.
GPs may be able to use their discretion to a greater extent and extend the length of consultations if the drive to recruit new GPs and retain GPs considering leaving the profession is successful. In January 2015, health leaders announced a £10 million investment to expand the general practice workforce.
In the meantime, in an effort to improve standards the Care Quality Commission (CQC) has put failing GP practices in special measures. GP practices that provide inadequate care will be given deadlines for improvement or face closures under a new system of ‘special measures’ which were proposed in August 2014. It appears that the CQC have taken a strict approach, and inspectors have put three GP surgeries under special measures for the first time. Practices in Reading, Liverpool and Sale, Cheshire have been told to make major improvements urgently or face being closed after being rated as offering patients an inadequate service overall. All three practices have six months in which to dramatically overhaul how they operate.