As GPs continue to try to balance access issues with continuity of care for patients, Mohammed Ahmed Rashid
explores the case for ‘standing consultations’ to reduce the time GPs spend sitting at work and to send health messages to patients.
He outlines how a two tier appointment model using two types of consultation might ease access issues. Shorter standing appointments could be made available on the day for single acute problems and tackle paucity of access. Meanwhile, non-urgent, longer, sitting appointments could be offered to give time to tackle the complexity of chronic disease management, multimorbidity, and psychosocial illness, and thus protect continuity for patient groups who most need and want it.
Standing for acute consultations would decrease sitting time and gently signal to both doctor and patient that time is limited. Although standing consultations may be considered radical and prove unpopular for some,there is always a need to consider and debate innovations that may benefit patients, clinicians,or both. Behavioural change remains a struggle to implement, and the most successful strategies are increasingly thought to be those cued to environmental
stimuli, implicitly modifying daily activities without the need for conscious decision making. Modifying our occupational environment is a clear example of this. Introducing this change to our practice also serves to promote
a culture of attending to our own wellbeing.
The prevailing convention in UK general practice is a “one size fits all” appointment model for consultations, and clinicians are stranded in their chairs throughout the working week. The UK has a shortage of general practitioners, and as well as tackling recruitment, the challenge is also to ensure that clinicians remain healthy and able to work. As such, the negative health effect of prolonged sitting at work may be an important element to consider when designing future models for general practice.
Mohammed Ahmed Rashid is academic clinical fellow, Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge.