Should the number of GP's patient consultations be capped?

May 09, 2018

The British Medical Association recently proposed guidance to cap the number of patients a GP sees each day to prevent unsafe working levels, but should this be recommended? Experts debate the issue in The BMJ today.

Limits to workload could protect GPs and patients in a system that has become dangerous, says Laurence Buckman, a GP partner in London.

10 minute consultations are too short for the amount of work patients' needs require and the pressure to perform better and longer for more patients is now dangerous for both doctors and patients, he explains.

Genuine emergencies should not be limited, but most so called emergencies are for minor ailments or simple queries and none of these justify working into the evening. He adds: "Every problem is important to every patient, and we should recognise that, but we cannot keep giving until we might make a potentially serious error or become ill ourselves through overwork".

He points out that many GPs start out with a 'fixed number' of appointments - 18 consultations in each half day. "But we also have a policy to turn away nobody who says he or she is in need. We cope with this load" he says.

"The time has come when the public has to be told that it is unsafe for them to be seen when the GP is not thinking optimally, and that a tired GP risks harming patient - and doctor" he concludes.

But Michael Griffiths, a GP partner in South Wales, says caps inhibit professionalism and might themselves cause harm.

He points out that successive governments and management regimes have gradually transferred more work, until the [medical] profession feels overwhelmed by the excessive workload and patient safety is compromised.

"[Capping appointments] is the wrong way, because it limits our flexibility and professionalism when dealing with patients, but mainly because it does not address the question of bringing additional resources into primary care to manage work that we could undertake if properly funded.

"A cap may be a useful negotiating tool, but it should never become an end in itself. What is needed is a greater proportion of NHS resource coming to primary care to allow us to properly administer our practices, allowing the right professional enough time to devote to each patient," he concludes.

In a linked patient commentary, Jennifer Skillen, a frequent primary care patient, acknowledges that sometimes only a face to face appointment with a GP is suitable.

"A fifth of patients are already having to wait more than two weeks for an appointment, which is too long. Introducing caps to the number of daily consultations would likely make this unsafe situation worse.

"What the NHS needs is fundamental system change. We must look beyond short-term tweaks and develop long term strategies in the NHS that support GPs to support patients," she concludes.


Related Primary Care Articles from Brightsurf:

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Continuity of English primary care has worsened with GP expansions
A new study published by the British Journal of General Practice has found that patients' abilities to see their preferred GP has fallen greater in English practices that have expanded, compared with those that stayed about the same size.

Primary care office-based vs telemedicine care visits during COVID-19 pandemic
This observational study quantified national changes in the volume, type and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based visits compared with telemedicine encounters.

Expenditures for primary care may affect how primary care is delivered
This study looks at trends in out-of-pocket and total visit expenditures for visits to primary care physicians.

Primary care clinicians drove increasing use of Medicare's chronic care management codes
To address the problem of care fragmentation for Medicare recipients with multiple chronic conditions, Medicare introduced Chronic Care Management (CCM) in 2015 to reimburse clinicians for care management and coordination.

Primary care at a crossroads: Experts call for change
Primary care providers have experienced a rise in responsibilities with little or no increase in the time they have to get it all done, or reduction in the number of patients assigned to them.

Primary care physicians during the COVID-19 epidemic
Scientists from the University of Geneva has analysed clinical data from more than 1,500 ambulatory patients tested for COVID-19.

The five phases of pandemic care for primary care
The authors present a roadmap for necessary primary care practice transformations to care for patients and communities during the COVID-19 pandemic.

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

Read More: Primary Care News and Primary Care Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to