An end to the standard 10-minute GP consultation to allow family doctors to spend more time with patients with complex needs is core to the Royal College of GPs' vision for the future of general practice.
It states that by 2030 face-to-face GP consultations will be at least 15 minutes, with longer for those patients who need it.
Recent research showed that the UK offers some of the shortest GP consultations amongst economically-advanced nations at 9.2 minutes – with another study finding that the average GP consultation involved discussion of two and a half health problems.
It's estimated that the number of people with a single chronic condition increased by 4%, and with multiple chronic conditions by 8% per year between 2003/4-2015/16 – and that patients with long-term conditions account for around 50% of all GP appointments.
10-minute appointments unfit for purpose
Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said: "It is abundantly clear that the standard 10-minute appointment is unfit for purpose. It's increasingly rare for a patient to present with a just single health condition, and we cannot deal with this adequately in 10 minutes.
"GPs we want to deliver truly holistic care to our patients, considering all the physical, psychological and social factors potentially impacting on their health. But this depends on us having more time to spend with patients, and the resources and people to allow us to do this.
"NHS bodies across the UK do not stipulate how long GP appointments should be, but GP workload is soaring, GP numbers are falling, and patients are already waiting too long to secure an appointment as a result. Without more resources and an expanded workforce, longer consultations would simply mean increased waiting times, undermining patients' ability to access the care that they need."
Fit for the Future – the College's vision of what general practice will look like in 2030 - was informed through consultation with more than 3,000 GPs, other health professionals and patients, as well as research commissioned from The King's Fund. It also predicts:
- An overhaul of the GP-patient record into a personalised 'data dashboard', accessible by healthcare professionals across the NHS, and that will draw on data from the patient's genomic profile and wearable monitoring devices.
- Networks of GP practices will evolve into 'wellbeing hubs' with expanded teams offering a wider range of services, both clinical and non-clinical – and that access will increasingly be via digital and video channels.
- Continuity of care will be maintained and improved but delivered via 'micro-teams', so that alongside having a named GP, patients can build long-term relationships with several members of a multi-disciplinary team. The GP team will include established nursing and pharmacy roles, but also emerging roles, such as physiotherapists, occupational therapists, link workers, dieticians and health coaches.
- GPs will no longer work in isolation – practices will work in networks or clusters, allowing them to pool resources and people, but facilitating smaller practices to retain their independence and patient lists.
- A greater use of AI to improve triage systems that assess the severity of a patient’s health needs, enhance diagnosis, flag 'at risk' patients, and safely identify the most appropriate care pathway.
Making the wider NHS more sustainable
Professor Stokes-Lampard said: "Much of what we envision for the future of our profession we are already embarking upon in some form or another – but we need to make sure that whatever we do is safe, evidence-based and ultimately works to make general practice and the wider NHS more sustainable. In many cases, we're simply not there, yet.
"Ours is an ambitious vision but it is not a pipe dream. Realising it will depend on having a sufficiently resourced service to keep people well and provide them with the care they need around the clock, and we have identified several key enablers to deliver this.
"With these building blocks in place we can not only deliver world class, patient-centred primary care, we can ensure that being a GP is the best job in the world."
The College's report states that realising the vision is predicated on six 'enablers', including that general practice receives at least 11% of the NHS budget in all four nations of the UK; the full-time equivalent GP workforce expands by thousands, as does the wider practice team workforce; and that GP specialty training is extended to at least four years to expose trainees to the full breadth of skills and conditions they are likely to need and see in general practice.
The RCGP will now develop four 'roadmaps' outlining in more detail what needs to be done to realise its vision and advocating to governments and decision-makers in England, Scotland, Wales and Northern Ireland how to deliver it.
Professor Stokes-Lampard added: "Across the UK, patients have consistently high levels of trust and satisfaction in their GP service – they value general practice, the continuity of care it delivers, and how GPs and our teams deliver care close to home, thereby alleviating pressures across the NHS. We must protect our profession, and nurture it, for the sake of our GP workforce, the wider NHS and our patients.
"Things are incredibly tough at the moment for many working in general practice, but we have had promises of more funding, resources and GPs across the UK, a new five-year GP contract in England promising to ensure money gets to the front line of patient care, new contracts in Wales and Scotland, and new state-backed indemnity schemes in England and Wales.
"The pieces of the jigsaw are fitting together, and our vision should be the final piece, showing what the end result should look like – a thriving general practice service, continuing to keep the rest of the NHS sustainable and our patients safe - and how to achieve it.
"If everything is implemented effectively, we are at the dawn of a new era and I'm optimistic that the future of our profession - of the NHS, and patient care - is a bright one."