Pulse scrutinises a headline by the Daily Mail saying that GPs are ‘putting patients at risk’ by ‘rushing’ them with 10 minute appointments.
Another day, another Daily Mail headline attacking GPs. This week, the issue at hand is patients being put at risk by GPs rushing them out in 10-minute appointments. The data comes from a survey conducted by Ipsos (exclusively for the Mail and the Guardian) looking at the public’s perception and attitudes toward GPs. We look behind this ‘damning’ survey to see what is actually going on.
‘[Slapdash] GPs are putting patients at risk of harm by rushing them out of the door before they have time to discuss all of their issues, a damning survey suggests.’
As is often the case, the most blame lies with the subeditors who write the headlines – and this one is particularly egregious (although, thankfully, the ‘slapdash’ in the URL was taken out of the headline).
We know there are 330 fewer full-time equivalent GPs than this time last year. Meanwhile, appointment numbers have gone up dramatically: in July 31.7m appointments were delivered; up from 27.8m the previous year. The demand for appointments has increased, but the capacity to deliver is just not there. We do not have enough GPs in the system to be able to give everyone a longer appointment, without dramatically cutting access and appointment slots.
Most importantly, GPs absolutely agree that ten minutes is too short…
‘Most [survey respondents] believe the standard 10 minute appointment is too short to meet the needs of an ageing population, which is increasingly living with multiple conditions.’
This is certainly true, but it is only much later in the article that a crucial point is made – that GPs believe this as much as patients.
There is no contractual stipulation for appointments to be 10 minutes, but it is the generally accepted standard for practices across the UK – one of the shortest in Europe.
In 2021, GP leaders voted in favour of pushing 15 minutes to be the standard time allotted for appointments. Earlier this year, the BMA refreshed its ‘safe working guidance’ to recommend that practices take ‘immediate measures’ to move towards 15-minute appointments, citing reducing the need for repeated consultations and to ‘preserve patient satisfaction.’
The Daily Mail and the Guardian do half the work here by noting the fact that we do have an ageing population with increasingly complex and comorbid conditions. But in the Ipsos survey, 55-75 year olds had the highest rate of being able to discuss ‘everything’ or ‘most things’ with their GP (54%). Furthermore, a recent study published in the British Journal of General Practice found that patients were actually having longer consultations with GPs. The study’s authors concluded that this was because of the fact that almost one person in three is now multimorbid. Of the 550m records that were analysed in the study, it was revealed that consultation rates were higher for older patients.
‘Only half (51%) of UK adults said they were able to discuss “everything” or “most things” during their last appointment with a family doctor.’
Obviously, this is quite a low figure and understandably frustrating for any patients who feel that they did not manage to discuss all that they wanted to. However, there are larger surveys that contradict the negative patient experience that is being put across here.
The latest GP Patient survey showed that just under three quarters (73.9%) of patients had a ‘good’ overall experience of their GP practice. Meanwhile, 89.9% said that their ‘needs were met’ at their last appointment. Both the GP Patient Survey and the one used by the Mail and the Guardian were carried out by Ipsos: the former was carried out over three months and received just under 700,000 responses; the latter over a four day period and with just over 1,000 respondents. That is not to say that the latter survey is useless – snapshots are useful – but more to give the results context.
‘More than half (56%) say their surgery should make it easier to get a face-to-face appointment, 53% want shorter waiting times, and 52% say the booking process should be improved, with 33% wanting receptionists to pick up the phone faster.’
A Pulse analysis into GP access showed how in order to meet demand for face-to-face consultations, practices would have to generally provide longer waiting times, and with a healthcare professional other than GPs. It also revealed that practices with older populations tended to have a higher percentage of face-to face consultations. So, to offer more face-to-face appointments, other conveniences and privileges that patients expect have to fall by the wayside. The only way to have more face-to-face appointments, with GPs, without increased waiting times is to have… more GPs in the NHS. I’m sure we don’t need to remind you of falling GP numbers.
When it comes to booking an appointment, and wanting ‘receptionists to pick up the phone faster’, this seems to contradict a previous Daily Mail story. In June, Pulse analysed another article lamenting that ‘receptionists outnumber GPs at over 90% of surgeries.’ General practice needs more people in all areas of the workforce – including receptionists – to deal with patient demand. If you want receptionists to pick up the phones faster, more receptionists is what you need.
‘When they do finally get through, 43% find they have to tell the receptionist their issue before being graced with an in-person consultation with a GP, 22% must fill in a form on their practice website and 16% submit a request through the NHS app.’
Something that seems to be missing in every conversation about ‘having to tell a receptionist’ or ‘fill in a form’ about their issue in order to get an appointment is the reasoning as to why that is. Not every malady needs a GP and pre-consultation triaging allows for patients to be directed efficiently to where they need to go. This frees up GP appointments for those who do need them.
At the end of the day, it goes without saying here that GPs routinely work beyond their contractual obligations – hence phase one of collective action being to simply… work to contract. But GPs do so much work outside of their core contract to plug gaps in other areas of the NHS. If it seems like they are rushing a patient it is not because they don’t care about the patient, but more to do with the insurmountable workload dump and admin they have to deal with.
GPs are not ‘pushing patients out of the door’. Six in ten GPs do not feel they have enough time in appointments to ‘adequately assess and treat patients.’ This is an issue felt by both sides. But, we need to understand why this is the case – and villainising GPs is not the answer.
Most common reason for trying to rush a patient out?
The chemist is about to close.
Second – patient needs to collect children from school, dinner from oven, meet a delivery, get to work.
Another is – you are supposed to be at the hospital, not here, very very soon (although often too late by then); and just occasionally – you need to be in AE ASAP for treatment (given the ‘golden hour’ is taken up by 75 minutes of travel in our area)
Peolle also forget that the 10 minutes include the time for the patient to get from the waiting room to sitting down in the surgery. This ranges from at least 1 minute to 5 minutes, especialy in surgeries where the gp has to walk to the waiting room to call the patient….