This all reminds me so much of staff training days in schools. When there are no children around the staff can all get so much done. Then all the children come back and it's mayhem. Seems to me all public services run much more smoothly without the clients. So I can see that bureaucracy has made GPs lives hell too. However, teachers must meet the needs of their pupils and GPs must meet the needs of their patients. Therefore, it might be a good idea for doctors to make it clear that the time allocation is 10mins and to explain why.

jill cooper, rugby, u.k.

The government spin machine is keeping up the relentless GP bashing I see. I fail to understand the DOH's argument: just because GPs are paid a reasonable salary does not mean they can magically create more time. The DOH should leave GPs alone to do what they are good at - managing patients.

Peter Jeffreys, Leeds, UK

Don't forget that after you have dealt with the five problems presented and have taken 30-40 minutes in doing so, you then have to write it up as a consultation on the computer and code all the entries and make sure the codes match with the prescriptions. On top of this you then have to do all the Government requested health check info and make sure that you haven't missed anything from the five consultations in your write up. It is usual to forget at least one of the issues by this time so that there is no record on the next visit. The write up will take 10 minutes itself so now you are 40-50 minutes behind and your surgery has been blown out of the water.

The patient who comes afterwards with a serious problem will then not mention that as they can see that you are behind and will try to help you catch up by omitting it.

We all have responsibilities not to abuse services in this way for our own health and for others.

John, Notts, UK

Sarah-Kate,
You're very welcome to spend a few days in my practice in order to improve your understanding of primary care.
Best wishes
Dr Zoe Goodman

Zoe Goodman, Leeds, UK

My husband thinks we should have a clock on the desk that goes 'ping' after 10 minutes to remind the patient their time is up, it doesn't matter how many ailments they manage to fit into the time. I prefer to ask for the list and then asking the patient which one he wants to discuss today.

Sometimes it's very helpful to hear everything the patient has wrong with them as things they may feel are separate illnesses may all be indicative of one underlying condition such as diabetes.

Dr. Angela Steele, Cambridge, UK

If patients have more problems they can book extra time, I don't see the problem. That it how it works in The Netherlands, and it works well. To me it sometimes looks like that there are no doctors involved in health policy in the UK. Who is behind this statement and did he speak with a doctor before publising it?

petra, manchester,

What a jumble of spurious arguments from the DOH. What do GPs earnings have to do with time management? Even if they earned a million pounds a minute, the minute would still be 60seconds long. This is just another piece of propoganda from the department of negative spin. Leave the notices up and if patients ask, explain their rationale.
GPs want to be able to give their patients the best and that can't be hurried. Leave GPs to manage how they deliver the care and be critical about the outcome if you wish, not the method, then in the end the patients and not the politicians will decide.

Bru, Sidlesham, uk

It strikes me as rather strange that our goverment can postpone the reading of proposed legislation in parliament to the next session due to time pressures but GP's are expected to squeeze a quart into a pint pot! For years the government has been telling us we should be more like supermarkets - well open your eyes have none of you MPs never been into Tesco's and seen notices up stating express checkout - oh silly me I forgot MPs don't shop in Tesco's do they - just John Lewis stores and at the tax payers expense! I say consider this approach as the express surgery 3 items or less. There is a limit as to how much can be achieved in 10 minutes. Some patients will come in and rattle off 10 problems they want sorted which often takes them several minutes - often by the time they have finished I have difficulty remembering what the first problem is. This is not a safe way to practice medicine - if we try ro rush things and squeeze too much in then we are at risk of missing something.

Craig Thompson, Banff, Aberdeenshire

This is nothing to do with targets, but to do with patient safety.
We book at 10 minutes which is just about enough time to deal with one 'major' problm or two quickies. But if a patient has 3 or 4 unrelated problems then is it really safe to try to deal with each in only 3 minutes? Of course not. It is equally unacceptable to jsut deal with them all at the expense of the patients in the waiting room who might be acutely ill.
Part of a GP's in such cases is to deal with the most pressing probelm or two first, then get the patient back for the others. This is not meeting targets, being greedy or unreasonable, but about providing a safe service for ALL patients.

Dr Andrew Green, Hull, East Yorkshire

Yet another example of how the media/government/public have no idea how the health service works. It's quite simple really. It's a matter of time and resources. Of course doctors could spend 20, 30, or 40 minutes on each patient in order to deal with every problem their heart desires. Unfortunately that means that less than half the number of patients can be seen. So instead of waiting 2 weeks for your appointment, patients would have to wait 4 or 6 weeks.

Unfortunately there is a lot of selfishness displayed by patients and although they may complain when they have to wait 30 minutes for their appointment due to the surgery running late, they will then come in with their own list of problems. They then expect all these to be dealt with, and have no thought for the people waiting after them.

Once Labour has its way however, and the NHS is private then this issue will disappear. When patients have to pay per 10 minute appointment you can bet they will not run over time......

GP, Swansea, UK

It should not be assumed that patients even know how many problems they have. A rash plus a sore throat might add up to syphilis, a stiff neck and a temperature to meningitis. Most doctors are aware that they need to see the whole picture. My bet is that this idiot idea came from a "practice manager"

Rosemary, Germany,

Some parts of the UK have a less than satisfactory arrangement with their local healthcare provider, resulting in long, long expensive journeys to alternative GP practices or walk in clinics miles away, some not able to have house visits even for emergencies, so there must be some flexibility to take in some cases more than one ailment at a time, however it is a terrible shame that neither the DoH or other regulatory bodies move to put these situations on fairer footings which would enable well performing, smooth running GP surgeries to get on with their own work load, rather than mopping up patients from other areas, and would surely stem some of the vital money draining out .Patients and GP's want the best service, nobody want to complain, especially as complaining about the NHS is so dangerous for patients and medics alike.

mary foord-brown, suffolk coastal,

Is it any wonder complex health issues such as ME (Myalgic Encephalomyelitis) are given such short shrift and thrown into the (wholly inaccurate) psychsomatic 'dustbin'.
Through recent gene research this illness has been shown to be multi-systemic consequently resulting in a marked range of disparate symptoms. If one is only allowed to discuss one element of such an illness how on earth can proper diagnosis ever take place?

Related to the problem: I suppose I must consider myself lucky in that I have a surgery with no appointment system - you just turn up. I imagine there are constraints on time, but it seems a great deal less pressured than other group practices in the locality.

RCox, Cardiff,

We don't limit patients to one problem, but consider. If you were the patient with the child with the very high temperature who was feeling ill, and your GP is listening to the third problem on the present patient's list, having spent ten minutes on each the first two, and was taking the third ten minutes.

Perhaps we should make every appointment for thirty minutes and you would need three times as many GP as now, with three times the oft-repeated £100,000 per annum.

We GP have been trying to juggle with too many patients with insufficient time for years, and bear in mind, that rather than the (again) oft-repeated lie of GPs always on the golf course actually work 50 hours a week ( not all face to face, but we have administration, referral letters, reviewing tests done, phoning about patients etc)

All these attacks are to make GPs look like idle luddites to amke the public feel that the coming privatisation is a good idea.

Tony le Vann, doncaster, s yorks

So, Sarah Kate Templeton would be happy then, to wait without complaining, if her GP was running an hour and a half late because, say, three patients in front of her in the queue had come into their ten minute appointments with 6 or 7 problems ( which is not unusual ) and taken 40 minutes each ?

Most GP`s will simply ask for a list of the problems, deal with the msot pressing first then if there is no time left, arrange for the patient to return to discuss the rest . What would your health correspondant have them do instead?

Incidentally, a very large number of GP`s earn nothing like the £100,000 you keep going on and on about. Salaried GPs who make up an increasingly large portion of the workforce now, earn about half of this sum on average. The government and media are sounding like a stuck record repetitively droning on about this alleged £100,000 untruth.

Dr G Roberts, Folkestone, UK

This is the way it should be. If I have two legal problems I would certainly make sure the receptionist is aware so that the solicitor is advised.

Please leave the GPs alone -- they have a hard job to do in a very target-orientated environment. And prioritising your complaints is what they are experts at!

Christopher, Lancaster, UK

Patients often do not realise that their appointment is for just ten minutes. My surgeries are fully booked. The only people that suffer if someone takes up more than ten minutes are the other patients. They have to wait while I am running 30-40 minutes late. They are the ones whose time is wasted.

With all best will in the world I cannot create more time out of a ten minute appointment. We understand that many symptoms may be related and we do our best to deal with them but often I am presented with three or even four problems that are totally separate and each need ten minutes to do them justice. Then we may ask patients to rebook to have the other problems dealt with properly. If patients know they have complex problems they should book a double appointment so that they do not waste the time of subsequent patients.

Monica, dover, kent

Typical of targets driving bad practice. The patients needs come last but the politicians are kept happy. If my GP can't see you in 48 hrs you are asked to call back to make an appointment the next day or, if its urgent, to go to A & E!

keith winstanley, Preston,