Intended for healthcare professionals

Rapid response to:

Head To Head

Should GPs’ daily number of consultations be capped?

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k1947 (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?

It would be interesting to view a fresh perspective on the problem being discussed, where the number of patients seen per day may indicate necessity rather than systems inadequacy. If a “GP” is defined as the person of first contact who sees a patient directly, in a developing economy like India, a great majority of the GPs would end up seeing more than 50 to 100 patients per day. In a working day comprising of 8 hours, this would mean approximately 5 to 9 minutes per patient, a fact presented in a survey published in 1999. This picture is complicated by the fact that a majority of India’s healthcare is unorganized, and consists of practitioners in remote or rural areas. This places enormous stress on first contact providers who are seeing more than 50 patients per day, usually with extremely limited facilities and little or no patient insurance, with increasing fear of patient violence, leaving little room for adherence to guidelines and formal assessment of quality of care. In addition, traditional systems of medicine are also approached by a number of patients, with greater tendency to self-medicate.

Government run hospitals bear the brunt of this burden, and doctors frequently have no time to discuss minutiae of treatment involved. Antagonistic to increasing demand, a majority of doctors working in India are in the private sector. Although a tiered system is functional in multiple places, it is not universal (unlike the NHS). In a nationwide survey published in 2014, a major difference in healthcare utilization across different states and socioeconomic backgrounds was noted, showing underutilization of healthcare by those with lower incomes, indicating an unmet need for subsidized, government initiated healthcare.

So what is the answer? Tertiary care that is subject to quality control is too few and far apart, and strengthening primary care with streamlining of referrals is probably the only option. Inclusion of private institutions to receive primary care referrals would offload a number of government hospitals and likely provide impetus for change in the future. In addition, as more and more medical care in the future is going to be specialized, it would set the foundation for better organization in the future.

What is a safe number of patients to be seen in one day? Like any other statistic, it’s good to have a range, from 10 in super specialty clinics to probably more than 50 at the grassroots level.

References
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Bhat R. Characteristics of private medical practice in India: a provider perspective. Health policy and planning. 1999 Jan 1;14(1):26-37.

Ambesh P. Violence against doctors in the Indian subcontinent: a rising bane. Indian heart journal. 2016 Sep 1;68(5):749-50.

Rudra S, Kalra A, Kumar A, Joe W (2017) Utilization of alternative systems of medicine as health care services in India: Evidence on AYUSH care from NSS 2014. PLOS ONE 12(5): e0176916
Ghosh S. Equity in the utilization of healthcare services in India: evidence from National Sample Survey. International journal of health policy and management. 2014 Jan;2(1):29.

Competing interests: No competing interests

17 May 2018
Suvir Singh
Hematology, Oncology and Stem Cell Transplant Physician
Ludhiana