Blog by Natasha Elmore, Research Associate, Cambridge Centre for Health Services Research
Consultation length in general practice has been a subject of interest to GPs and policy makers for decades. Whilst it appears to be generally accepted amongst GPs that the standard ten-minute consultation is no longer adequate or sustainable, there is continued debate between clinicians and policy makers as to how we improve access to GP services and achieve better quality of care without compromising consultation length.
Good patient experience is a key element of achieving high quality health care, yet little research to date has studied how consultation length may impact on patient experience of communication. This is often evaluated through patient experience surveys, such as the GP Patient Survey and made publicly available through websites such as NHS Choices and I want great care.
More time in the consultation has been linked with a number of patient health-related outcomes, including better control of high blood pressure, and better recognition and management of psychosocial illnesses, although a recent review has suggested that this evidence is weak.
Previous studies have investigated the effect of consultation length on various outcomes including patient satisfaction as one element of patient experience but few have used robust methods to do this, and none have looked at this relationship at an individual level (as opposed to a sessional level).
In our study, recently published in the British Journal of General Practice, we aimed to examine the relationship between consultation length, and patient reported experience of communication, trust and confidence in the doctor seen, and patient satisfaction. We also wanted to find out if the time taken for the GP to conduct an examination or interruptions, or whether the patient seeing their preferred doctor made any difference to this potential relationship.
We conducted secondary data analysis of 440 videoed consultations and their linked patient questionnaire which asked about each patient’s experience of the communication in the consultation recorded, from 13 general practices in England. Specifically we examined the relationship between consultation length and a number of patient experience outcomes: overall communication with the doctor; trust and confidence in the doctor; and patient satisfaction. We watched and recorded the length of each consultation, including noting time taken for examinations and interruptions to the consultation. We found that there was no evidence of a relationship between consultation length and patient-reported experience, as measured by our outcomes. This finding did not change when we adjusted our analysis to account for differences in patient age, gender, ethnicity, self-rated health or doctor gender. We also found that seeing their preferred doctor, or examinations or interruptions also did not change these results.
Our findings suggest that patients can experience good communication and be satisfied with shorter consultations as well as longer ones. Whilst we are not suggesting that more time in the consultation isn’t important for other aspects of quality of care, our results suggest that doctors may already be skilled at judging how long individual patients need in a consultation.
– Natasha Elmore
One explanation for these findings may be that doctors are already skilled at estimating the length of time required for consultations on an individual basis: a follow-up consultation with a well-known patient may be appropriately short, but consultations discussing psychological conditions for example, may require longer. Longer consultations do not appear to be a key driver for patients to report a good experience with their doctors. However, longer consultations may still be important for clinical effectiveness and patient safety: two other key elements for achieving and maintaining high quality of care, particularly for those with multi-morbid conditions and complex health conditions.
N Elmore, J Burt, F A Maratos, J Campbell, et al Investigating the relationship between consultation length and patient experience: a cross-sectional study in primary care British Journal of General Practice.
Image: Dr Jon Ferdinand for the Primary Care Unit