RCGP annual conference, Harrogate, 2013

1. Caring against the clock:
Overview of the evidence
Greg Irving

2. “7 minutes had become the summary
statistic of the day”
Sir Denis Pereira Gray PRCGP
1998
Pereira Gray D. BJGP. 1998;48:1816–1817

3. Year 1997 2006 2008
Mean consultation
length (mins) (DDRB)
9.37
Mean no consultation
/ year (GHS)
5
Mean no.
consultations (any
health professional) /
year (NHS IC)
4.01
Mean number of
consultations / year
(NHS IC)
2.92
Total time / year
(GHS) (mins)
47
Total time /year (NHS
IC) (mins)
27.8
DDRB: Doctors and Dentists Review Body
GHS: General Household Survey
NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404

4. Year 1997 2006 2008
Mean consultation
length (mins) (DDRB)
9.37 11.7
Mean no consultation
/ year (GHS)
5 4
Mean no.
consultations (any
health professional) /
year (NHS IC)
4.01 5.22
Mean number of
consultations / year
(NHS IC)
2.92 3.23
Total time / year
(GHS) (mins)
47 47
Total time /year (NHS
IC) (mins)
27.8 37.8
DDRB: Doctors and Dentists Review Body
GHS: General Household Survey
NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404

5. Year 1997 2006 2008
Mean consultation
length (mins) (DDRB)
9.37 11.7 -
Mean no consultation
/ year (GHS)
5 4 -
Mean no.
consultations (any
health professional) /
year (NHS IC)
4.01 5.22 5.5
Mean number of
consultations / year
(NHS IC)
2.92 3.23 3.4
Total time / year
(GHS) (mins)
47 47 -
Total time /year (NHS
IC) (mins)
27.8 37.8 -
DDRB: Doctors and Dentists Review Body
GHS: General Household Survey
NHS IC: NHS Information Centre Irving G et al. BJGP 2012;62:404

6. Average consultation length (min)
*Based on best available evidence from each country *Methodological heterogeneity
21
18.5
15.6
15 15 14.8
13
12 11.7 11.5
10.2
9
7.8 7.6
6.6
6 5.9 5.7
0
5
10
15
20
25

7. • Survey of 3713 GP principles in Scotland 2001
• 21% felt not currently providing high-quality
holistic care
• Average consultation length 9.3 minutes
• 30% provided less than 10 minutes
• 5% provided more than 10 minutes
Holism in primary care
Hasegawa H et al. PHCRD 2005; 6: 320–328

8. Hasegawa H et al. PHCRD 2005; 6: 320–328

9. • 40% felt rushed at end of consultations (>50%
consultations)
• Booked consultation length was shorter in
urban & deprived areas
• Mean optimum consultation length was 13.3
mins
– 43.3% between 10 - 15 mins
– 39.8% specified 15 mins
– 9.9% > 15 mins
Holism in primary care
Hasegawa H et al. PHCRD 2005; 6: 320–328

10. Consultation length Routine Emergency
0.5 - 4.5 mins 2 (0.3%) 5 (0.8%)
5 - 9.5 mins 18 (2.7%) 157 (24.8%)
10 - 14.5 mins 575 (85.4%) 360 (56.9%)
15 - 19.5 mins 52 (7.7%) 37 (5.85%)
20 - 24.5 mins 12 (1.78%) 10 (1.6%)
>25 mins 0 0
No set time 14 (2.1%) 64 (10.0%)
• 2010 UK Cross sectional survey
• Consultation length offered by GP trainers
Irving et al. BJGP 2011; 62 (12):238
n=673

11. Systematic review (Hutton et al 2007)
• Focus on psychological problems
• 29 studies included
• Consultations with a recorded diagnosis of a psychological problem
were longer.
• GPs reported that time pressure is a major barrier to treating
depression.
• Evidence that increased consultation length is associated with more
accurate diagnosis of psychological problems.
Hutton C et al. BMC HSR 2007; 7: 71

12. Cochrane review (Wilson et al 2009)
• 4 trials : Short term, not of high quality, 1978-1992
• Insufficient evidence to say whether increasing consultation
length provides patient benefit (or not)
• With longer consultations
• More health promotion
• Doctors did not run more tests, examine or refer more
• Patients were not any more satisfied with care
• Patients did not alter follow-up behavior
Wilson A et al. Cochrane Database of Systematic Reviews 2006;1:CD003540