Chris Lancelot: Time is of the essence, so why take it away?

Whenever I try to reduce the length of my consultations I become aware that I am starting to take risks - specifically, through assuming that the most superficially apparent diagnosis will prove to be the correct one. Generally I am right, but sooner or later the need to cut corners risks a delayed or missed diagnosis.

That chest pain - musculoskeletal, of course. (Am I really sure?) A temporary change in bowel habit, with a few spots of blood? (His piles, presumably.) That worsening depression? (She won't commit suicide - I hope ...)

We've all had similar experiences. Speed up the delivery of medicine and corners get cut, diagnoses are missed and treatment becomes protracted. Alternatively, with not enough time for further detailed investigation the next step is a referral - which might well be unnecessary. Either way, the patients lose out.

So I read with incredulity that in order to close a funding gap of £5 billion by 2017, NHS London has apparently suggested cutting the length of GP appointments by 33 per cent while simultaneously reducing hospital referrals and A&E attendances by more than 55 per cent.

Clearly, London's healthcare finances are in a desperate state, but even worse, some managers appear to think that this proposed solution may work. Yet anyone with hands-on experience of primary care knows it won't - indeed, it can't.

Reducing referral rates is difficult enough in the best of circumstances. Even if a reduction were possible, it could only be achieved if the GP spends more time with the patient, investigating and treating.

So for NHS London to assume that a reduction in referrals might be achieved at the same time as shortening GP appointments seems little short of madness. Its actions display a total lack of understanding of the processes involved in diagnosis and treatment.

I can see why some might think that NHS London's plan would solve its financial problems, however, as all GPs know, delivering high-quality, efficient and economic healthcare needs time - lots of it.

How long will it be before NHS managers learn this lesson?

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