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The contractor ensures that the length of routine booked appointments with doctors in the surgery is not less than 10 minutes. If the contractor routinely admits extra patients during booked surgeries, then the average booked consultation length should allow for the average number of extra patients seen in a surgery session such that the length of booked appointment is not less than 10 minutes.If the extra patients are seen at the end of surgery, then it is not necessary to make this adjustment.
For contractors with only an open surgery system, the average face-to-face time spent by the GP with the patient is not less than 8 minutes.
Contractors that routinely operate a mixed economy of booked and open surgeries should ensure that the length of booked appointments is not less than 10 minutes and the length of open surgery appointments is not less than 8 minutes.
The QOF includes an incentive for contractors 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.
For contractors where patients are seen in booked appointments of ten minutes or more and surgery sessions are not interrupted by extra patients, the contract requirement is met. In this case, non-booked consultations for extra patients who need to be assessed on the same day would take place at the end of surgery, after the booked appointments.
If extra patients 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 ten minute intervals, but six extra patients are routinely added in, then the average time for patients will be 120/19 which equals 6.7 minutes. These slots would not meet the ten minute requirement. If the contractor routinely admits extra patients during booked surgeries, then the average booked consultation length should allow for the average number of extra patients seen in a surgery session such that the length of booked appointment is not less than ten minutes.
Some contractors do not run an appointment system. In this case, or where some surgeries are regularly 'open', contractors are advised to measure the actual time of consultations in two separate sample weeks during each year.
For contractors using computerised clinical systems, the length of routine consultations can be recorded automatically from the computer. Where actual consultation length is measured, the face-to-face time with patients in routine consultations is not to be less than eight minutes.
Contractors organise consulting in a wide variety of ways. This guidance covers the majority of systems. Where different systems are used, the contractor will need to assess whether the indicator requirements are still met and declare achievement accordingly. It is for the NHS CB to decide whether it requires further information to verify that this is the case.
For contractors where patients are seen for routine appointments in booked appointments for ten minutes or more and surgery sessions are not interrupted by 'extras' the contract requirement is met. For contractors with only open surgery systems, the average consultation time is not to be less than eight minutes. For contractors operating a mixed economy, booked appointments are not to be less than 10 minutes and open surgery appointments not less than eight minutes.
If the NHS CB requires evidence that this indicator has been met, contractors may carry out a survey on two separate weeks of consultation length either manually of through a computer should be made available upon request.
Verification - if the contractor operates an appointment system, the NHS CB may inspect the appointments book (whether paper or computerised), looking at a sample of days over the preceding year. In reviewing this data, the contractor may be required to provide a number of sample days to confirm that routine consultations have been booked at least at ten minute intervals.
Prepared By Jean Keenan