More than half of GP consultations with adults 'impossible in 10 minutes'

More than half of GP consultations with patients aged 18 or over cannot be managed within 10 minutes, GP leaders have warned, after research found patients with multimorbidity account for around 53% of appointments in this group.

Both the BMA and RCGP have said repeatedly that 10-minute consultations are inadequate in the face of rising demand and complexity of patients, but research published in the British Journal of General Practice reveals the extent of the mismatch between the UK population and the 10-minute consultation model.

Data from more than 400,000 patients - balanced to be representative of people aged 18 or over in England - found that 27.2% had multimorbidity. This suggests that of the roughly 41m people aged 18 or over in England, over 11m have multimorbidity.

The researchers found that this cohort accounts for 52.9% of consultations in primary care among patients aged 18 or over. Lead researcher Anna Cassell, of the University of Utah, US, told GPonline that just over 2m consultations per year took place among the sample group - which suggests that that as many as 112m primary care consultations per year in England involve patients with multimorbidity.

Workload advice published this month by the BMA warns that 'anything over 15 doctor-patient contacts for long-term, complex or mental health conditions' per day may be unsafe 'due to the more demanding nature of the consultations'.

GP workload

However, one in six GPs currently deliver 40-60 consultations per full day on average, according to a GPonline poll that found most GPs would support a cap on consultations - with most favouring an upper limit of around 30 per day. If the mix of cases these GPs see each day reflects the workload found in this latest research, it suggests they are working at a level far beyond what can be considered safe.

The researchers found that every age group of patients over 55 years old had more than one morbidity on average, with those aged 55-64 facing 1.31 morbidities on average, rising to 2.06 in those aged 65-74, 2.97 among 75- to 84-year-olds and 3.65 among those aged 85 or over.

Patients with multimorbidity visited their GP 2.56 times as often as patients without multimorbidity, the researchers found. One in three patients with multimorbidity had both a physical and a mental morbidity, they added.

GPC chair Dr Richard Vautrey told GPonline: 'As people live with more conditions they need more and more care. They may attend with one issue in mind, but may in fact have three, four or even five issues that need addressing and to do that in a 10-minute consultation is not possible.'

The BMA's GP leader said the research showed that more than half of GP consultations with adults were not suitable for the 10-minute appointment model. Research published last year suggested that GPs in the UK currently allow less than 10 minutes per consultation on average.

Restructuring services

RCGP Professor Helen Stokes-Lampard said the findings were 'further evidence of the increasing complexity of cases that GPs are dealing with, and the inadequacy of the standard 10-minute consultation'.

She added: 'While GP workload has increased by at least 16% over the last decade, our work has also increased in complexity - but the share of the overall NHS budget general practice receives is less than it was a decade ago, and our workforce has not risen at pace with demand.'

The researchers suggested it may be necessary to consider a 'drastic restructuring of services; no longer will people be seen in "single disease" services but in new multimorbidity clinics designed for the future'.

Dr Vautrey said more collaboration was vital 'to avoid the current bizarre situation where patients are referred to a hospital specialist and then sent back to their GP to be sent to another hospital department'.

'We are increasingly seeing patients with a whole library of appointment letters, because they are expected to visit a large number of different specialties separately. We need to provide more one-stop care for these patients. That is what general practice is doing increasingly - trying not to limit patients to one individual issue per consultation.'

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