What can improve the health of the nation? Longer GP consulations

Dr Muiris Houston: Minister, modify doctors’ payments to include longer consultations

Researchers have found that patients given the longer consultations had a drop in ‘negative wellbeing’ and scored more highly for quality of life

Researchers have found that patients given the longer consultations had a drop in ‘negative wellbeing’ and scored more highly for quality of life

 

“The value of the research is that it allows people using our health services to tell us what they think in their own words and in terms of their own experiences, perceptions and hopes.” Simon Harris

Minister for Health Simon Harris was speaking at the launch of My Healthcare, My Future, commissioned by the pharmaceutical company MSD, and carried out by Ipsos MRBI among a representative sample of the general population and medical professionals. The headline finding of the survey was that respondents were equally divided in their pessimism and optimism about the future of healthcare in Ireland.

But beyond the headlines are some helpful pointers as to where Irish people see value in the health service. Some 93 per cent would prefer to be treated by GPs and pharmacists rather than having to visit a hospital. And speed of service and being treated with respect were high on the 1,000 respondents’ “wish list”.

Some specific findings caught my eye, such as 86 per cent of respondents say it is very important that their illness or condition will be clearly explained to them in language they understand.

The report also found that Irish people look to their healthcare professional for empathy and guidance and say they are willing to be involved in decision-making around any treatment they require (85 per cent), with nine out of 10 people saying they are willing to ask questions if they don’t understand what a medical professional tells them.

What is the best way to ensure people are treated with respect and are communicated with to a degree that allows them feel fully involved with decision making around their health?

Time. It’s the key driver of quality for doctor-patient interactions. And it’s a scarce commodity in our ailing public health system. If a clear majority of us want to be treated with respect in the community, as the MSD research suggests, then we need to inject a large bolus of time into consultations with primary healthcare professionals.

Is there any evidence that doing so would work? According to Scottish research published earlier this year, extending appointments with GPs to 30 minutes would be more cost-effective than many prescription drugs. It found that patients who had more time with a doctor or practice nurse enjoyed better health a year later than those offered the usual 10-minute slot.

Some 152 patients in the study were in their 50s and from eight GP practices; patients in four locations were given 30-minute appointments with specific follow up; while those in the other four practices received standard 10-minute appointments and usual care. Each patient had five chronic conditions including asthma, diabetes, arthritis and chronic obstructive pulmonary disease.

Researchers from Glasgow and Dundee universities, writing in the journal BMC Medicine, found patients given the longer consultations had a drop in “negative wellbeing” and scored more highly for quality of life. Those who had shorter appointments, however, saw their health continue to decline.

From a cost perspective, the longer appointments cost £929 (€1,033) more per patient per year than the standard GP services. But using the standard measure of “quality year” of healthy life, the authors calculated the longer appointments cost £12,224 (€13,583) for each extra quality year of life gained. This is well within the cost effectiveness cut-off point used by health watchdogs such as Nice in the UK and Hiqa here.

Commenting on their findings, Dr Graham Watt, a professor of general practice and primary care at the University of Glasgow, said: “If this was a drug or a bit of equipment it would just sail in. There would be no argument about whether the NHS should be doing it.”

Minister, you are in the middle of negotiating a new GP contract. Modify doctors’ payments to include longer consultations for patients with multiple chronic conditions and enjoy the legacy of the single best intervention you could make to improve the nation’s health.

mhoutson@irishtimes.com

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