Under their contract, practices must provide appointments sufficient to meet the reasonable need of their patients, although neither GMS nor PMS Contracts specify a fixed number per practice population. This will be influenced by the practice population, but must be done in a way that is safe for patients and GPs. 
 
Signposting and triage are safe and effective ways of delivering care, although not all practices will wish to adopt a “total triage” model. Utilising these methods means  practices can: 

• provide patient appointments more flexibly and utilise other members of the practice team, clinical or administrative
• direct patients to the most appropriate provider of care, which may not be a member of the practice team.
• prioritise care for those most in need. 

An ageing population, increasing medical complexity and rising multi- co-morbidities require longer patient contacts. We strongly recommend practices move to an average of 15-minute appointments. There is no requirement within the GMS/PMS contract that defines the length of a patient contact. 
 
Many practices still provide care at 10-minute intervals that is supposed to allow time for record keeping, and housekeeping between patients. This differs from many other similar primary healthcare systems. It also is at odds with evidence around quality of care. 
 
By extending appointments to an average of 15 minutes, practices can reduce the need for repeated contacts with patients while still preserving quality of care and patient satisfaction. It can also support continuity of care, which is increasingly recognised as one of the key contributors to better patient outcomes and experiences. 
 
This should be done without increasing the total time GPs spend consulting in their day, meaning, for most practices, a reduction in the absolute number of appointments per session. This is to ensure GPs and other clinicians can practice safely. The focus must be on delivering safe, high-quality care driven by the needs of the patients and their practices. 

Current BMA standards for a session of GP care is 4 hours 10 minutes. No more than 3 hours of this should be spent in contact with patients. Within these limits, adequate rest breaks must be taken. Extending sessions beyond this time risks harm to patients and clinicians. 

These recommendations apply to all GPs working within practices, including partners, salaried colleagues and locums engaged temporarily. 

For salaried GPs who are regularly exceeding their contracted hours, a reduction in appointments is one possible intervention, whether these be face to face, telephone calls, visits, or e consults.