RCGP should press for increase in resources

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7269.1160/a (Published 04 November 2000) Cite this as: BMJ 2000;321:1160
  1. Guy Johnson, general practitioner
  1. Sighthill Health Centre, Edinburgh EH11 4AU

    EDITOR—I share Toft's evident disappointment in his royal college's efforts in trying to maintain a decent standard of clinical practice.1 I am a general practitioner, and as part of its contribution to revalidation and clinical governance the Royal College of General Practitioners (Scotland) published a detailed practice accreditation document in July 1999. This is generally a well thought out and comprehensive list of criteria that practices should aspire to in order to achieve basic and more advanced levels of accreditation. It seems to me, however, to have one profoundly disappointing flaw: little importance is given to spending adequate time with patients.

    Although a 10 minute consultation is recognised as necessary for the highest level of accreditation, a practice can still be accredited as an acceptable practice if a patient is seen every two or three minutes. Common sense and experience show that it is quite impossible to deal adequately with many of our patients' complex problems in this sort of time, let alone elicit hidden symptoms or problems, engage in health promotion, or treat our patients with compassion and humanity. Howie et al's research into consultations shows conclusively the greater effectiveness and value to patients of a 10 minute consultation.2

    Resources seem stretched to their limit. In general practice one obvious answer would be for the Royal College of General Practitioners to press much more strongly for an increase in resources, which would allow us to have smaller list sizes. We do, after all, compare badly with many other western European countries in the number of general practitioners per head of population. To suggest that a practice that sees 12 or 20 patients in an hour deserves some sort of accreditation undermines the hard work of general practitioners who spend longer with their patients, and it is insulting to patients to suggest that they should be satisfied with this.


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