I can tell you how the practice I’m working in at the moment is set up.
Each doctor has a consulting room they sit in. The patients come to them from the waiting room.
Unlike US doctors offices there is no requirement to strip off and wear a gown- I’ll talk to you, decide what examination you require and ask you to remove the relevant clothing at that point.
I have 15 minute appointment slots because as a junior GP I need more time. The senior partners have 10 minute slots. My slots are usually booked up about 3 days in advance, but I have one empty slot in the morning at 10am and one in the afternoon at 4pm that I can put an emergency into, although mostly I use the time to catch up on paperwork or prevent myself running too late.
There is always a “duty dr”- one of the GPs who has no booked patients in their slots. They’ll use the time to answer phone calls, see walk-ins and do paperwork (checking results from hospitals, issuing telephoned prescription requests, reading letters from specialists etc).
The surgery opens at 8:30am and my first patient is at 9am. I’ll use that first 30minutes to briefly read the notes of the patients coming that morning to prepare myself, check to see if there are any blood or Xray results that need actioned and finish any outstanding paperwork.
I’ll have patients between 9am and 11:15am, aiming to catch up on paperwork (referral letters mostly) from those appointments until 11:45am. At 11:45 all the doctors meet for tea and biscuits- we discuss any issues arising fro the morning surgeries, and if there are any housecall requests that have come in we decide who goes to see which patient.
At 12pm we go back to our surgeries for allocated telephone time with patients until 12:30pm. Usually people telephone requesting antibiotics for chest infection, or sicklines, or emergency contraception, to discuss new medications, or to find out if their symptoms warrant an appointment. At 12:30pm I grab a sandwich at my desk and finish up any work from the morning.
Housecalls (usually 1, but can be up to 5, anywhere within a 5mile radius) between 12:45 and 2pm. Most often they are calls to terminally ill or housebound elderly patients or nursing homes. Occasionally they are calls to confirm a death or a post-bereavement courtesy call. Sometimes they are emergencies and you have to stay until an ambulance or the police arrive.
The surgery re-opens at 2pm, with paperwork from the housecalls, preparation for the afternoon surgery or work from the afternoon post delivery taking up the time until 2:30pm. More telephone calls from 2:30-3pm, with the first patient of the afternoon at 3pm and the last patient at 5pm, with paperwork from these patients until the surgery closes at 6pm, and occasionally a final housecall on the way home .
The latest I have personally run is 30minutes, when my first patient of the afternoon surgery turned out to be having a nervous breakdown, which required rather longer than the allotted time to sort out. About 80% of the time I call my patient within 5minutes of their allotted time.
Our system is that the nurses run their own clinics with their own appointment system. If somebody needs blood tests or an ECG I’ll usually ask them to make an appointment with the nurse unless there is a pressing reason why it has to be done immediately, in which case I’ll do it myself. If the nurses have an issue (a wound they’re dressing looks infected, or somebody’s asthma medications need changed) they’ll usually phone one of the GPs to come and give them a hand.
We have quite a few patients who turn up early and expect to be seen sooner, or who turn up 2 minutes before their slot ends but just before the next patient arrives, or who simply arrive late and expect to be seen anyway. Sometimes you can’t blame the doctor, and instead need to blame the other patients!
Barring an emergency 90minutes is just bad time management and disorganisation.
