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The length of routine booked appointments with the doctors in the practice is not less than ten minutes. (If the practice routinely sees extras during booked surgeries, then the average booked consultation length should allow for the average number of extras seen in a surgery session. If the extras are seen at the end, then it is not necessary to make this adjustment.)
For practices with only an open surgery system, the average face-to-face time spent by the GP with the patient is at least eight minutes.
Practices that routinely operate a mixed economy of booked and open surgeries should report on both criteria.
The contract includes an incentive for practices to provide longer consultations. This has been included as a proxy for many of the things that are crucial parts of general practice, yet cannot easily be measured e.g. listening to patients, taking time, involving patients in decisions, explaining treatments, in addition to providing high quality care for the many conditions not specifically included in the QOF.
Practices can claim this payment if their normal booking interval is 10 minutes or more. ‘Normal’ means that three quarters or more of their appointments should be 10 minutes or longer. Deciding whether a practice meets this requirement depends on the booking system.
For practices where three quarters of patients are seen in booked appointments of 10 minutes or more, and surgery sessions are not normally interrupted by ‘extras’, the contract requirement is met. Extras seen at the end of surgeries and patients seen in emergency surgeries should then not amount to more than a quarter of patients seen.
If extras are routinely seen during surgeries, this will reduce the effective length of time for consultation. For example, if a surgery session has 12 consultations booked at 10 minute intervals, but six extras are routinely added in, then the average time for patients will be 120/18 = 6.7 minutes, and these slots would not meet the 10 minute requirement. Practices will generally find it easier to decide whether they meet the ‘three quarters’ requirement if extras are seen at the end of routine surgeries, rather than fitted in during them.
Some practices use booking systems which contain a mixture of slots booked at different lengths within a single surgery. In these practices, the overall number of slots which are 10 minutes or more in length should be three quarters of the total.
Some practices do not run an appointment system. In this case, or where some surgeries are regularly ‘open’, practices should measure the actual time of consultations in two separate sample weeks during each year. It is not necessary to do this if fewer than a quarter of patients are seen in open surgeries and the rest of the surgeries are booked at intervals of 10 minutes or more, as the ‘three quarters’ requirement will already be met.
For practices using computerised clinical systems, the length of consultations can be recorded automatically from the computer, providing the doctors know that it is being used for this purpose during the week. Where actual consultation length is measured, the average time with patients should be at least 7.25 minutes. This assumes that the face to face time has been 8 minutes in three quarters of consultations (equivalent to the face to face time in a 10 minute booked slot), and 5 minutes in the remainder.
Practices organise consulting in a wide variety of different ways. This Guidance covers the majority of systems. However, if the practice believes that the spirit of the indicator is met but that the evidence it can provide is different, it should have discussions with the PCO at an early stage.
For practices where three quarters of patients are seen in booked appointments of 10 minutes or more and surgery sessions are not normally interrupted by ‘extras’ the contract requirement is met. Practices should submit a statement to this effect. (Grade A)
For other practices, claiming against this indicator, a survey carried out on two separate weeks of consultation length or a computer printout which details the average consultation length should be available. (Grade A)
If the practice operates an appointment system, inspection of the appointments book (whether paper or computerised) should be carried out, looking at a sample of days over the preceding year.
If the practice has submitted a survey of consultation length, this should be reviewed.
The assessors may need to look at a number of sample days to confirm that 75 per cent of consultations have been booked at least at 10 minute intervals.
If a manual survey of average consultation time has been submitted the assessors should question the doctors and reception staff on how and when this was carried out.
Prepared By Jean Keenan