The NHS in London is currently in a bit of a pickle. It is aware that money will be tight in the future (with most of governmental spending these days seemingly necessary to save the Royal Bank of Scotland), so together with those friendly efficiency creaters from McKinsey it has started to look where it could make some savings. One of their ideas would be to ‘reduce the unit cost in the non-acute sector’ by ‘radical measures in staff utilisation (66%), appointment times (33% reduction in PC[primary care]) and prescribing costs (10%-15%)’ (link here: Strategic Planning Guidance 2009 10 appendix1 HfL affordability assumptions).
Now, I am sure that we all approve of reduction in prescribing costs and utilising staff better, but I do take umbrage with the suggestion to reduce my consultation times. Most days I have a 3 hour surgery in the morning and the evening. In each 3 hour block I’ll see about 18-20 patients, most of them about 10 minutes each. You could argue that 10 minutes isn’t much for the complexity of primary care medicine, and you would likely have a point, but after a long time coming, ten minutes has been the norm for consultations in general practice. Of course, neither doctor nor patient get the full ten minutes, as the clock doesn’t start when the patient sits down in front of the doctor, having taken his or her coat off. No, the clock starts when the doctor calls the patient from the waiting room. Depending on disability or injury, the way from the waiting room to the consulation room can be a long and slow one, so by the time the patient arrives, a third of the consultation might already be over. If patient and doctor are staisfied at the end of the consultation that everything is sorted, a plan is in place, concerns discussed, the doctor still has to meticulously document everything that happened within the consultation. Only then the next patient can be called in.
This shows you two things:
- how immensely important good timekeeping is within general practice (imagine a 5 minute overlap for the first 17 patients in a 3 hour surgery: that would mean an 85 minutes wait for the patient who had an appointment at the end of the surgery).
- how absolutely impossible it would be to reduce consultation times to 7 minutes. Experience shows that the only thing this results in is decreased satisfaction for both patient and doctor and an increased rate of referrals, as your GP has less time to sort things out on a primary care level.
As unnecessary referrals are a terribly expensive way to conduct medicine, the NHS in London is likely to pay more for their scheme to reduce consultation time. Nevertheless, that’s what happens if you invite consultants like McKinsey who have no interest beyond the obvious cost savings and are not interested in either the consequences or the ‘soft’ (i.e. relational) side of medicine.
The NHS London insists this plan was widely consulted on.
Ah.