Our patients are so much more than their symptoms and diseases; as general practitioners it’s our role to decipher what’s really going on and to make the most comprehensive and appropriate diagnosis and treatment plan, based on myriad factors.
It is this holistic, truly person-centred care that every GP aspires to deliver, but pressures on NHS general practice, indeed, the entire NHS, make it increasingly difficult for us to give our patients this kind of attention.
It is incredibly frustrating and stressful as a clinician to not have sufficient time with a patient to get to grips with the various physical, psychological, and social factors potentially impacting on their health.
In the UK, we are seriously lagging behind other countries in terms of how long we spend in our GP consultations—for those in Lithuania, Belgium, Portugal, Luxembourg, Iceland, Cyprus and Peru, a 15-minute consultation in standard, and in Sweden it’s 22.5 minutes on average.
Our patients deserve the same, particularly when we consider that our patients’ needs are gradually changing. We all recognise that the population is living longer, and thus developing more chronic, complex illnesses that require high levels of monitoring and management and, this should not be rushed.
Every consultation is unique and important, but I especially don’t want to rush more complex cases and neither, understandably, do my patients.
We need to work towards 15 minutes as the minimum standard time with our patients—and of course, longer for those who need it. But offering longer appointments means offering fewer appointments—as we already work far too many hours each day.
With demand escalating, and GP numbers falling across the UK, patients are already waiting far too long for an appointment in many areas, so there has to be a major increase in system capacity to allow all GPs to be able to make this change. Some have already implemented longer consultations and they report high satisfaction for all parties and reduced reattendances.
We know that because many patients are waiting so long to get an appointment that suits them and their lives, patients frequently come to their consultation with a number of conditions they want to discuss—and if we don’t have sufficient time to discuss them properly this adds to both clinician and patient stress and frustration.
More time for GPs to spend with patients is central to Fit for the Future—the College’s recently articulated vision for general practice—and to be able to offer longer appointments, we need investment in our service and we have to build a sustainable workforce for the future.
But we also need to think about doing things differently.
We need to expand the capacity of GPs by optimising their time through greater use of our highly-trained and skilled wider practice team members, allowing us to focus on the most complex patients. And we need to work better together, across teams and practices, so that we can pool resources and people, while designing systems that maintain and encourage the continuity of care we know patients and GPs value, and allowing smaller practices to retain their autonomy.
We also need to utilise technology in ways that are safe for patients and their data, but also reduce our workload, for example, the introduction of initiatives that cut bureaucracy and red tape, and decent, intelligent triage systems that navigate patients to the most appropriate care and services.
Realising this vision is predicated on six “enablers,” including that general practice receives at least 11% of the NHS budget in all four nations of the UK; the full-time equivalent GP workforce expands by thousands, as does the wider practice team workforce; and that GP specialty training is extended to at least four years to expose trainees to the full breadth of skills and conditions they are likely to need and see in general practice.
We’ve already had pledges of more investment and more GPs from governments across the UK—we need to make sure these become a reality.
Our report appears deceptively simple, but it is actually an ambitious vision, realising it would address some of the biggest needs for general practice, the wider NHS and patient care.
The pieces of the jigsaw are fitting together, and if everything is implemented effectively, we are at the dawn of a new era and I’m optimistic that the future of our profession—of the NHS, and patient care—is a bright one.