Intended for healthcare professionals

Head To Head

Should GPs’ daily number of consultations be capped?

BMJ 2018; 361 doi: (Published 09 May 2018) Cite this as: BMJ 2018;361:k1947

Patient commentary

General practice needs radical reform, not tweaks like consultation caps

  1. Laurence Buckman, GP partner1,
  2. Michael Griffiths, GP partner2
  1. 1London, UK
  2. 2Caerphilly, UK
  1. Correspondence to: L Buckman l.buckman{at}, M Griffiths dickyskin{at}

Limits to workload could protect GPs and patients in a system that has become dangerous, says Laurence Buckman, but Michael Griffiths says arbitrary caps inhibit professionalism and autonomy and might cause harm

Yes—Laurence Buckman

If we admit that GPs become less safe the longer they work, we could harm the profession. However, the 10 minute consultation is too short for the amount of work required to meet patients’ needs. And the pressure to perform better and longer for more and more patients, with greater degrees of complexity, is now dangerous—for them and us. 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 tired GPs risk harming patients—and themselves through stress associated illness. I am not prepared to die for the NHS.

The first medical commandment is to do no harm. We must no longer squeeze what needs to be done for patients into 10 minutes. We must stop pretending that we can see potentially unlimited numbers of possibly sick people without respite. We must support the BMA’s recent call to limit the daily number of consultations.1

No limit for genuine emergencies

Of course, we should not limit genuine emergencies, but fortunately these are rare. Most so called emergencies are for minor ailments, certificates, insurance forms, or simple queries, and none of these justifies working into the evening.

Most practices triage their excess workload to allow patients with emergencies to be seen while controlling the deluge of people with problems who are less sick or not sick at all. Every problem is important to every patient, and we should recognise that, but …

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