Old people with docResearchers are calling for GPs to spend longer with patients who have multiple health and social problems, following a study published in BMC Medicine, which found that extended consultations helped improve quality of life over the long term. 

Typical doctor surgeries arrange consultations for ten minutes which enable patients and practitioners to focus on one, typically medical, problem. However, it is common, particularly in areas of high deprivation, for people to have lots of medical problems as well as mental health and social problems, which make it harder for their GPs to adequately get to the bottom of issues that may affect the management of health problems in a short amount of time.

Glasgow Caledonian University’s Dr Rosaleen O’Brien, along with researchers from the Universities of Glasgow and Dundee, developed the CARE (Connect, Assess, Respond, Empower) Plus study to establish if longer (30-minute) consultations changed the way doctors thought about the illnesses they were presented with and the treatments they offered, and whether this would improve outcomes for their patients.

Eight practices in deprived parts of Glasgow took part in the study, of which four health centres in offered an enhanced care programme. Researchers worked closely with these four surgeries, which were given time to offer patients aged between 30 and 65 with a complicated mix of problems (physical, mental and social problems) ‘holistic’ longer appointments which lasted half an hour or more.

During the extended consultations, GPs dealt with all the patients’ issues, agreed a care plan with them and goals to aim for that might improve quality of life, as well as follow-up sessions. The GPs and practice nurses who delivered CARE Plus received training and the surgeries were given money to hire locums, releasing the doctors to spend time on the extended consultations. Patients who received this extra attention were found to be comparatively better a year later than a group of similar patients, who declined in health, having received a standard service from their GP.

Medical Sociologist Dr O’Brien, who led the qualitative work that helped inform the development and evaluation of the CARE Plus trial, said that the standard trial measures used might underplay the benefits of the intervention to the CARE Plus group. She said: “Qualitative interviews produced more nuanced, and positive, findings about the benefits of CARE Plus. Most patients and practitioners interviewed had noticed marked improvements to wellbeing. When noticeable change to quality of life had not yet been experienced by patients, some felt that the extra support they had received had set them on the right path to health improvements.

“The act of giving patients extra time seemed to have particular significance in this social setting of high deprivation; to many patients extra time indicated they were being valued and this boosted their sense of self-worth. In the longer term, this could have real benefits and primary care providers should be encouraged to think creatively about how they could reconfigure their services to give more time to those who would benefit most.”