Can longer consultations really save time and resources?

It has been argued that increasing the length of general practice consultations will save time and resources. Yet two letters in this week's BMJ suggest that longer consultations may lead to higher health service costs and might necessitate redeployment of pharmacists.

Phil Wilson and colleagues carried out a pilot study with six general practitioners in Glasgow to assess the effect of increased consultation time on patients' psychological distress. Each doctor's surgery was randomised to either 10 minutes per patient (the normal booking interval) or 15 minutes. After the consultation, patients completed a general health questionnaire.

Although the consultation interval increased by 50%, consultation length increased by only 12%. This raises the question of what the doctors did with the extra time, say the authors. When the doctors had longer booking intervals, they performed more tests and asked more patients to make return appointments. Perhaps doctors given more time with patients simply uncover more problems, they suggest.

The results of this short-term study must be interpreted with caution, say the authors. "Our data suggest, however, that longer consultation intervals may cost more than remuneration for extra general practitioners' time."

The only way for doctors to have more time is for them to stop doing things, argue Arnold Zermansky and colleagues in an accompanying letter. For instance, a move from repeat prescribing to repeat dispensing would probably save the average general practitioner about an hour a day.

The extended roles of practice nurses and nurse practitioners are a move in this direction, but there are so many calls on nurses that we are probably close to the limit of available staff.

The largest untapped source of underused skill is community pharmacists, say the authors. The potential exists to redeploy pharmacists into general practices to review patients and supervise drugs, making best use

Contact: Emma Wilkinson
BMJ-British Medical Journal

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