Thursday, 21 January 2010


If there's one thing that I dislike about being a GP in the NHS, it's the terrible ten minute appointment slots. Let me take you through a typical morning to show you why:

8.30am - Patient 1 arrives

8.40am - Patient 1 leaves (well done me I think, an impressive start)

8.43am - Patient 2 arrives (he doesn't think he's late, I do)

8.50am - Patient 3 arrives

8.55am - Patient 2 leaves. Patient 3 enters and promptly bursts into tears.

9.00am - Patient 4 arrives

9.10am - Patient 5 arrives

9.20am - Patient 6 arrives

9.30am - Patient 7 arrives. I'm still with Patient 3. Very subtly (years of practice) I manage to flick to my computer's control screen. I see the word "waiting" repeated again and again down the morning list. I panic. I manage to lose Patient 3. But it's too late. I know that I am now destined to spend the rest of the morning frantically trying to catch up on time at the expense of listening to my patients. The day will pass in a frenzy of irritated patients, inadequate consultations and an increasingly stressed me.

I suppose to be fair, there are a few things that can be done in 10 minutes. Dealing with coughs and colds, toenail infections, diagnosing an ear full of wax, boiling an egg, having a shower, feeding the dog (I hasten to add that not all of these are recommended work time activities). There are however, many things that can't. Managing depression, admitting a patient to hospital, dealing with a new diagnosis of diabetes. Oh yes, and of course the; "Well there are a few things actually doctor - I've made a list so I wouldn't forget them". Groan.

Thankfully the BMA have recently acknowledged this problem, detailing the need to lengthen GP appointments in their pre-election manifesto. Unfortunately however they have also admitted that this can only be 'an aspiration' since it would require many more doctors which is clearly unrealistic in the current climate. More groans.

I however have been lucky. The practice I have now joined does offer 15 minute appointments and whilst an extra 5 minutes may not seem like a lot, it has revolutionised my working life. I have started to enjoy my job again and I feel that I can do it properly now. I am happier and my patients are happier. I have more time to listen, time for health education, time even perhaps just to chat. We of course are fortunate that we are a small enough practice to do this and still be able to offer enough appointments to meet our targets, the majority can't. But having seen it work and seen the difference it makes, I will be championing the idea that in the case of appointment times, we really do need quantity to achieve quality.


  1. One of the GPs at the practice I used to visit would sometime arrange a "double slot," for certain patients who he knew may need extra time

  2. I rarely get an appointment to see my GP in person. If I ask for one, I get put through to the triage doctor and I'm amazed how quickly and efficiently they can deal with most stuff without the need for me to come in or even for me to wait long so long as I don't call at the start of the day.

  3. Years ago in Scotland I had a wonderful doctor: he practised with another doctor, not his partner, who was utterly different from Hamish. Dr no2 was shy and quiet, you went in, got what you needed and left. He was rarely behind and very good at his job despite being tongue-tied. Hamish, on the other hand, loved to talk to his patients - about everything, but above all, travel and, in particular, Italy. Their practice had very few appointments, there if you needed them, but generally you turned up and waited. If you were in a hurry, knew what you wanted, you turned up to see Dr no2. If you knew you needed a long time, to be listened to, to feel extra-loved, you went to Hamish's surgery. No-one ever complained. I had a similar GP in Germany - if you had to wait, you didn't mind. One day it would be your turn to need a half hour appointment slot and it would be there for you, no questions asked.