The recently published RCGP report on medical generalism brings into focus the need for GPs to spend more time with patients to deliver high quality generalist care.1 Historically, the figure of 47 minutes a year for the patient has been widely cited and discussed as a summary statistic for the total consultation time a GP spends with each patient per year.2–4 This figure was first proposed in 1998 by Professor Sir Dennis Pereira Gray as a challenge to the ‘7-minute consultation’ summary statistic of the day.5 The figure was based on a calculation using data from the Doctors’ and Dentists’ Review Board (DDRB) workload survey and the General Household survey (GHS), now known as the General Lifestyle survey (GLS).6,7
The DDRB consultation length figure is based on practice survey data and is estimated by dividing the average length of surgeries by the average number of patients seen.8 The GHS figure is based on patient recall of consultations with the GP during the last two weeks and multiplied by 26.9.
The GHS figures were reported to be broadly comparable with data published by the 2009 NHS Information Centre report that was based on trends in consultation rates calculated from computerised clinical records (QRESEARCH®).10 However, unlike the GHS, the NHS Information Centre (NHS IC) report provides a detailed breakdown for which primary care health professional the patient consulted (GP, nurse practitioner, or other). If the NHS IC figure is used to calculate the summary statistic instead of the GHS then it appears that the total time the patient spends with a GP may be less than 47 minutes (Table).
Table.
Consultation length
| Year | Mean consultation length (mins) | Mean number of GP consultations/year (GHS) | Mean number of consultations (any health professional)/year (NHS IC) | Mean number of consultations with a GP/year (NHS IC) | Total time/year (using GHS) (mins) | Total time/year (using NHS IC) |
|---|---|---|---|---|---|---|
| 1997 | 9.37 | 5 | 4.01 | 2.92 | 47 | 27.8 |
| 2006 | 11.7 | 4 | 5.22 | 3.23 | 47 | 37.8 |
| 2008 | — | — | 5.5 | 3.4 | — | — |
GHS data suggests total annual contact time remained the same (47 minutes) between 1997 and 2006, largely as a consequence of longer consultations in the face of a falling average number of consultations. In contrast the NHS IC data indicates that while total annual contact time with any health professional increased during this period, the total time spent with a GP has always been less than 47 minutes, reaching just under 38 minutes in 2006.
Clearly great caution is required when combining, interpreting, and generalising such crude summary statistics. The DDRB report acknowledges that the methodology used to estimate consultation length, dividing the average length of surgeries by the average number of patients seen, may over estimate consultation length (for example, by including interruptions and time spent waiting for patients to arrive/leave the room).8 Both the NHS IC and GHS demonstrate considerable variation in consultation rate according to variables such as age, sex, location, etc. The full NHS IC report is strengthened by adopting a number of methodological approaches to the data including various measurements of error, and weighted linear regression techniques.10 However, the figures presented raise several important points for reflection.
While 38 minutes is still a reasonable amount of time it may be a more sobering figure than that of 47 minutes. In reality, this figure could be even less given potential over estimation in the DDRB data. Furthermore, the 38-minute summary figure relates to the amount of time spent with any GP, we should not assume that it is representative of the time a patient spends with the same GP. This may bring into sharper focus the limited space for providing continuity of personal care and just how important each second we spend with each patient really is.
Perhaps the real summary statistic of interest is the amount of time a given patient spends with the same GP each year?
REFERENCES
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