Aging population and funding challenges could cause doctors in United States to shorten appointment slots for patients here as well

Across the globe, health systems share a common challenge: how to meet the steady increase in the number of patients demanding access to clinical care with a workforce of physicians, nurses, and clinicians that may be shrinking due to retirements and other factors. Pathologists and clinical laboratory managers will want to stay alert to these developments, because this same trend is at work within the United States.

The United Kingdom (UK) offers a good example of this problem. Claiming doctors are being “run into the ground,” general practitioners in the UK are calling for an end to the country’s standard 10-minute office visit and a decrease in the number of patients they see per week.

The British Medical Association (BMA) blames general practitioner (GP) burnout on:

• Rising demand from an aging population with multiple health needs;

• Physician and staff shortage; and

• Inadequate federal government funding for healthcare.

Those factors also are at play within the United States (US) healthcare system. The possibility exists that health system administrators might want to create a standard of 10-minute appointment intervals as a norm for primary care physicians in this country.

Lack of Supply and Funding Affecting Both the UK and US

Like many developed nations, the UK and US share common problems in healthcare. These include a patient demand for service that outstrips supply and health systems that do not have enough money to fund all healthcare needs. Years of medical costs rising faster than inflation and the current state of the economy only aggravate the situation.

BMA Report Proposes Longer Office Visits and Fewer Patients

General practitioners in the United Kingdom want to change the current requirement of 10-minute patient visits. In its 2016 report, “Safe Working Levels in General Practice,” the BMA outlined its proposal to increase the length of patient appointments to 15 minutes, an interval common in the United States and in many European Union countries. In addition, the organization is pushing for office visits to be limited to 25 patients per day per doctor, with a target of no more than 115 appointments per week.

“Many GPs are being forced to truncate care into an inadequate timeframe and deliver an unsafe number of consultations, seeing in some cases 40-60 patients a day,” stated Dr. Brian Balmer, who serves on the BMA’s General Practitioners Committee. He was quoted in a BMA website news story.

Dr. Brian Balmer, who serves on the British Medical Association’s General Practitioners Committee, argues that the National Health Service (NHS) must take steps to improve the workload for general practitioners in the United Kingdom. “General practice in the UK cannot be allowed to continue being run into the ground: it’s time for positive change that gives patients the care they deserve,” he stated. (Photo Copyright: GPonline.)

Dr. Brian Balmer, who serves on the British Medical Association’s General Practitioners Committee, argues that the National Health Service (NHS) must take steps to improve the workload for general practitioners in the United Kingdom. “General practice in the UK cannot be allowed to continue being run into the ground: it’s time for positive change that gives patients the care they deserve,” he stated. (Photo Copyright: GPonline.)

BMA Supports Creation of Locality Hubs

Rather than cancelling appointments that exceed the 115 per week target, the BMA is backing the creation of “locality hubs,” a central facility where demand, patient lists, and safe working limits would be managed for multiple local practices. This hub model is among the different provider models presented in the NHS’ “Five Year Forward View,” and is being considered as a future structure of the NHS.

In lobbying for change, Balmer added, “General practice in the UK cannot be allowed to continue being run into the ground: it’s time for positive change that gives patients the care they deserve.”

While the physicians group says doctors cannot treat patients properly under the current 10-minute office visit standard, a spokesperson for the NHS in England told The Independent, “How long to allocate to individual patient appointments is at the discretion of individual GP practices, based on patient need, and there are no national limits suggesting 10 minutes should be the norm.

“However, GPs are under pressure, so the recently published ‘General Practice Forward View’ is substantially increasing investment and reforming care to free up GPs to spend more time with patients.”

Patient Expectation and NHS Funding Motivates Existing Time Limit

According to a British Broadcasting Corporation (BBC) report, the time limit for general practitioner appointments in the United Kingdom was previously fixed at 10 minutes. However, that restriction was removed during contract negotiations in April 2014 with the BMA general practice negotiating team. Though there is no longer a national limit on appointment length, the NHS website continues to tell patients to expect to spend an average of eight to 10 minutes with their physicians during appointments.

While increased NHS funding will need to go hand-in-hand with longer patient appointment times, Dr. Zoe Norris, a GP and UK Chair of GPC Sessional Subcommittee, told The Guardian that the current system isn’t working for patients or primary care physicians, especially when patients present with more than one issue or need added assistance.

“As soon as you throw anything unusual into the mix you’re scuppered,” Norris said. “That might be you have got a complex patient [or] you might have a patient who needs help getting undressed. There’s no time to do the preventative things you need to do. It’s heartbreaking. I feel as though I’m doing half a job.”

What has gone undiscussed in the UK’s discussion about the proper length of time for a patient visit with general practitioners is the role of medical laboratory testing. Appropriate use of the right clinical laboratory testing at the right time for the right patient can do two things effectively. First, it can improve the physician’s ability to diagnose and develop treatments for each patient. Second, it can make general practitioners more productive in the time they have with patients.

—Andrea Downing Peck

Related Information:

10-Minute Limit Per Patient Runs British Doctors ‘Into the Ground’

Safe Working in General Practice

GP Appointments Should Be Five Minutes Longer, Says BMA

Quick Turnaround GP Appointments ‘Running General Practice into the Ground’

NHS England: Five-Year Forward View

NHS England: General Practice Forward View, April 2016

British Medical Association: A Vision for General Practice 2015

NHS General Practitioner Services

GP 10-Minute Rule Axed

Fifth of GP Premises Investments Under £1bn Government Scheme Face Cancellation, BMA Warns

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