Intended for healthcare professionals

Rapid response to:

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

Rapid Response:

Re: Should GPs’ daily number of consultations be capped?


Simple prescriptive solutions, such as consultation numbers per day, to the problem of increasingly unmanageable workload in primary care are not the answer.

Every patient presentation is unique. Every doctor is unique. The circumstances obtaining in every practice in the UK are unique. The answer lies in recognising this infinite diversity and making provision for individual personal judgement to forge a suitable answer in every instance - it used to be called professional autonomy and worked very well indeed.

Let clinicians be clinicians. Pernicious managerialism is the chief problem to be dealt with - millions of doctor hours are wasted every year on fatuous managerialism.

What would undoubtedly make a useful difference is placing iron constraints upon the squandering of scarce doctor hours on non clinical tasks. I offer the suggestion that each practitioner should be permitted to spend not less than 80% of their contracted hours each week in direct patient contact - face to face or home or phone/Skype consultation, 10% on back office tasks, 5% on meals, etc. and 5% on CPD.

Those practitioners who have a special predilection for managerial tasks, not more than, say, 5% of the workforce, should have custom made contracts to fit their individual circumstances and shoulder that burden for the clinically productive workforce entirely.

No practitioner should be obliged, expected, coerced or inveigled into undertaking tasks of any description outside their contracted hours.

If I had been allowed to do the job I joined and trained to do I would not have retired early. Many feel the same I am sure.

Yours sincerely
Steve Ford

Competing interests: No competing interests

12 May 2018
Steven Ford
Retired GP
Haydon Bridge