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?

Both the pro and con sides of the current argument are concerned about urgent situations if general practice has a hard consultation cap.<1> Consultation caps have been widely implemented in the Canadian primary care system for a long time.<2>. However, many walk-in clinics are available for patients who are unable to book an urgent appointment with their GPs. The downside is their GPs could lose their bonus payment if their patients frequently visit walk-in clinics.<3>

Should British GPs also have consultation caps like the Canadians? We would say yes, if the following conditions are met. First, the NHS must have more walk-in services to accommodate for patients who need urgent appointments, but are unable to see their registered GPs. Secondly, GPs should be encouraged to work extra shifts in walk-in clinics, and paid reasonable rates. This may reduce the work shortage crisis during weekends and evenings, and the workload of hospital emergency departments. Thirdly, if a GP’s patients choose to frequently visit walk-in clinics instead of their registered practice, the GP can de-register the patients from the practice.<3> Moreover, a practice should have the right to cap its number of registered patients to ensure patient safety.

Increasing the availability of walk-in clinics is only a short-term solution to the increasing workload in primary care. The long-term solution is none other than having more GPs to deliver adequate quality of care to each patient.

1. Buckman L, Griffiths M. Should GPs’ daily number of consultations be capped? BMJ. 2018;361:k1947.
2. Billing & payment guide for family health organization (FHO) physicians – opting for solo payment. Toronto, Canada: Ministry of Health and Long-Term Care; 2014 Nov; cited [2018 May 19]. Available from:
3. Why your walk-in clinic visits could mean trouble for your family doctor, and you. Toronto, Canada: Canadian Television Network; 2016 Feb 12; cited [2018 May 19]. Available from:

Competing interests: We have been paid for working as medical doctors, but not writing this letter.

21 May 2018
Eugene Y.H. Yeung
Medical Doctor
Roxanna S.D. Mohammed, Medical Doctor
Lancaster, UK