Evolving general practice consultation in Britain: issues of length and context
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7342.880 (Published 13 April 2002) Cite this as: BMJ 2002;324:880
- George K Freeman, professor of general practice (g.freeman@ic.ac.uk)a,
- John P Horder, past presidentb,
- John G R Howie, emeritus professor of general practicec,
- A Pali Hungin, professor of general practiced,
- Alison P Hill, general practitionere,
- Nayan C Shah, general practitionerb,
- Andrew Wilson, senior lecturerf
- a Centre for Primary Care and Social Medicine, Imperial College of Science, Technology and Medicine, London W6 8RP
- b Royal College of General Practitioners, London SW7 1PU
- c Department of General Practice, University of Edinburgh, Edinburgh EH8 9DX
- d Centre for Health Studies, University of Durham, Durham DH1 3HN
- e Kilburn Park Medical Centre, London NW6
- f Department of General Practice and Primary Health Care, University of Leicester, Leicester LE5 4PW
- Correspondence to: G Freeman
- Accepted 7 February 2002
In 1999 Shah1 and others said that the Royal College of General Practitioners should advocate longer consultations in general practice as a matter of policy. The college set up a working group chaired by A P Hungin, and a systematic review of literature on consultation length in general practice was commissioned. The working group agreed that the available evidence would be hard to interpret without discussion of the changing context within which consultations now take place. For many years general practitioners and those who have surveyed patients' opinions in the United Kingdom have complained about short consultation time, despite a steady increase in actual mean length. Recently Mechanic pointed out that this is also true in the United States.2 Is there any justification for a further increase in mean time allocated per consultation in general practice?
We report on the outcome of extensive debate among a group of general practitioners with an interest in the process of care, with reference to the interim findings of the commissioned systematic review and our personal databases. The review identified 14 relevant papers.
Summary points
Longer consultations are associated with a range of better patient outcomes
Modern consultations in general practice deal with patients with more serious and chronic conditions
Increasing patient participation means more complex interaction, which demands extra time
Difficulties with access and with loss of continuity add to perceived stress and poor performance and lead to further pressure on time
Longer consultations should be a professional priority, combined with increased use of technology and more flexible practice management to maximise interpersonal continuity
Research on implementation is needed
Longer consultations: benefits for patients
The systematic review consistently showed that doctors with longer consultation times prescribe less and offer more advice on lifestyle and other health promoting activities. Longer consultations have been significantly associated with better recognition and …