Contract needs to enable doctors to offer first class care

EDITOR—Jenkins et al found that patients vary both in what they want from a consultation with their general practitioner and in what they get.1 They found a poor correlation between these and the length of the consultation. The catchy front cover headline “Consultations don't have to be longer to be better” seriously overgeneralises these results. Some short consultations may be highly effective, but a systematic review earlier this year summarised a range of patient outcomes that are improved when doctors have more time.2

In one large English survey 12% of patients complained about having insufficient time with their general practitioner, but this figure rose to 30% when patients were seen for five minutes or less.3 It may be that the doctors need additional time in consultations—perhaps more than their patients. Medical practice has become more complex, and more needs to be done during the course of consultations. This may explain why clinical care is inferior in practices with short consultations.4 Patients may sometimes get what they want in short consultations—but they may not always realise that it isn't good medical care.

It is 16 years since David Morrell and I and colleagues published the first experimental study showing the limitations of short consultations.5 It is well past time to consign surgeries booked at intervals as short as five minutes to history. The current payment system for general practitioners encourages a “pack 'em in and sell 'em cheap” approach to general practice. This needs to be …