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EDUCATION AND DEBATE: Angela Coulter What do patients and the public want from primary care? BMJ 2005; 331: 1199-1201 [Full text]

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Allowing time for quality in general practice consultations

Nick A Francis   (23 November 2005)

NHS Reforms and Chinese proverbs

Michael H Martin-Smith   (23 November 2005)

Allowing time for quality in general practice consultations 23 November 2005
Nick A Francis, MRC Fellow Department of General Practice, Cardiff University, CF23 9PN Send response to journal: Re: Allowing time for quality in general practice consultations	The interesting article by Angela Coulter1 discusses a number of issues related to primary health care that patients and the public have identified as being important to them. I was surprised that although “time for care” was mentioned as being one of the more important factors in the systematic review by Wensing et al.2, it was not mentioned in the rest of Coulter’s article. Many of the things that patients want, like shared decision making and greater provision of information, are also increasingly recognised by the profession as important. But good communication takes time, and in the increasingly complex world of general practice, time is a scarce commodity. As Howie et al. showed in 1991, longer consultations are not only associated with greater patient satisfaction, they are also more likely to include health promotion and address relevant psycho-social issues3. Most GPs have made the move to a ten minute consultation, which is certainly an improvement on where things were a decade ago. But if we are serious about providing patients with the kind of service they want (and deserve), as well as engaging in health promotion, managing chronic diseases, and the myriad of other new tasks that GPs are involved in, surely we need to think about lengthening the consultation still further. References 1. Coulter A. What do patients and the public want from primary care? BMJ 2005; 331:1199-1201. 2. Wensing M, Jung HP, Mainz J, Olesen F, Grol R. A systematic review of the literature on patient priorities for general practice care. 1. Description of the research domaim. Soc Sci Med 1998;47:1573-88. 3. Howie JG, Porter AM, Heaney DJ, Hopton JL. Long to short consultation ratio: a proxy measure of quality of care for general practice. British Journal of General Practice 1991; 41(343):48-54. Competing interests: None declared
NHS Reforms and Chinese proverbs 23 November 2005
Michael H Martin-Smith, GP Principal Sydenham House Group Practice, Hull, HU3 2TA Send response to journal: Re: NHS Reforms and Chinese proverbs	The forthcoming NHS White Paper being prepared by The Rt Hon. Mrs Hewitt, is said to call for (yet more) major changes in Primary Care working practices - perhaps in order to compete with betting shops, public houses, and supermarkets? These proposed changes are supposedly based on the public's wishes as expressed in questionnaires. One is reminded that most turkeys, were they treated in the same way, would admit to enjoying Christmas - but not if they were reminded of their expected role in that Festival - or of taxpayers who regularly advocate higher taxes until they belatedly realise that they, too, pay tax! I have no doubt that, in asking for major changes in GP working practices, the public will in due course get them - but will they remember the old Chinese Proverb "Beware what you wish for - you may get it!"? I hereby promise that my working practices will be completely reformed beyond recognition within 18 months... Dr Michael Martin-Smith Competing interests: None declared