I read with interest the recent BJGPeditorial on 'Calling time on the 10-minute consultation'.1 As a recently qualified GP working in one of the most deprived and ethnically diverse areas of the UK the concept of a one size fits all 10-minute -consultation seems woefully outdated. As an individual practitioner I of course vary the length of my consultations based upon a multitude of patient factors, but there is always the underlying time pressure of a full surgery of patients waiting to be seen and of course the ubiquitous QOF targets. There is an undoubted effect of this time pressure on the way I practice, utilising time and follow-up appointments for complex cases. However, I wonder whether this time limitation could potentially impact on the ability of primary care practitioner's to make complex diagnoses early, a potential 'achilles heel' of general practice,2 thus adding to diagnostic delay and error, the biggest cause of medicolegal claims against GPs.3 Recent research has shown that health systems with a gatekeeper function have lower cancer 1-year survival4 Around 23% of patients consult three or more times with a GP before suspected cancer referral, with increased repeat consultations in those from ethnic minorities and for certain cancers before referral.5 A Cochrane review into the effects of changing the length of primary care consultations found a lack of evidence, with only five UK trials meeting the inclusion criteria, with most having methodological weaknesses.6 They make the case for further research in this area, as without evidence the 10-minute consultation may still be the norm in 20 years time.
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