It would be amazing to have longer appointments as I agree they’re really needed in this day and age, a typical GP appointment has changed beyond all recognition in terms of complexity but we’re somehow still expected to do everything in ten minutes! Technically GP partners could choose to have any length of appointments they like. But they’re also expected to run a certain level of service which requires a certain number of appointments, hitting certain targets which is hard to do without enough appointments, and also not to have patients waiting too long for an appointment, which makes it hard in practice to hugely change this. At the end of the day it is a business run for profit on increasingly small margins, so balancing everything up it’s not as easy as just making this change to appointment time. Some surgeries are changing to 15 minute appointments as standard but it’s difficult for this reason. Even if we didn’t have to meet a certain service standard, people would be most unhappy if they have to wait 2 months to see someone etc. and they could come to harm in the meantime.
It would also be lovely if we could get paid for the actual hours we work (particularly if working as a salaried GP like myself, employed by the GP partners, rather than as a partner who is essentially running a small business rather than being paid by the hour etc) regardless of what exactly we are doing in that time. But there is not a snowball’s chance in hell of that happening! Nobody is ever going to pay us more for working the same amount or less (you need to understand that any overtime is entirely unpaid).
The NHS way is for every last drop of work to be squeezed out of you and ideally for free as part of “goodwill” which has been increasingly used up over the years… and if you ever point out that you end up staying after hours to finish things it becomes “oh well you’re obviously not efficient enough then, so you have a problem with time management?” etc. Hence impossible amounts of work being booked in regularly where there is just no way of realistically fitting it all in to allocated hours, particularly if you care about doing it well or say things like “no you can’t discuss your mental health today, you are here for a painful knee and that’s all we can discuss today”.
I will say that some GPs are much better at generally keeping to time than others (quite often in reality it’s because of cutting corners in my opinion, though I did once work with a fantastic GP colleague who was just a fast consulter and generally kept to time but was really good at his job, I think it helped that he was very tech-savvy and worked with dual screens etc) and some surgeries have management that are much more supportive than others. So there are some GPs out there that leave the building at 6.30 when we shut along with the receptionists. But I think I’m far from being alone in it often being as late as 8.30 or even 9.30 on a bad day before being able to leave, especially if you don’t want to have to log in on a day off to catch up then, or come in super early instead (which actually a lot of GPs who appear to be good at managing time do - it’s just nobody realises they come in 2 hours early!)
I also don’t think it would suit everyone to spread out the appointments to make things less intense, even if they would pay us for doing so. A lot of GPs are female and have young children and childcare responsibilities, the ability to work part time and have more flexibility with hours and avoid working antisocial hours in general is often a huge pull factor as to why junior doctors choose to specialise as GPs rather than other specialties. It is changing but back in my day (and I qualified as a GP in 2010 so not CRAZILY long ago), this was simply not realistic in most other specialties in the same way it is for GPs.
For me personally I’d very happily stay until 8.30-9pm if paid to do so if the day in general was not so intense now my son is an adult, but for example a lot of parents of young children will want to leave to put their kids to bed then log back on from home after to file blood results and go through hospital letters etc. I used to do things that way myself, particularly as a single parent when my son was younger. This wouldn’t be possible if we were due to see patients then (it wouldn’t suit the people who come in 2 hours early either).
I also wouldn’t want to be doing that 5 days a week to be honest especially at this age and stage of life. I’d also very happily work 5 days a week if the work was less intense actually, indeed I could very much do with the money, the main reason I work part-time is that I cannot cope with the stress and long hours from such an intense job 5 days a week. I have bipolar disorder and have to protect my mental health for my own sake but also patients.
And although not every GP has mental health issues, I would say that actually the 3 day week for GPs has become more of a thing mainly because of work stress and intensity and long hours, making the job basically undoable 5 days a week unless you are extremely psychologically robust and a fast consulter with excellent time management, and are happy to catch up at weekends if needed. It is a source of much frustration to me that as a profession we have basically accepted that 3 days a week these days is as much as the average person can reasonably do in the job without burning out quickly which helps nobody. And so we have essentially accepted a huge pay cut in that way as our salaries have not been adjusted to compensate for that. When GPs are asked why they work part time, often they may say it’s for childcare or whatever because people understand that in a way that they don’t really understand having to work 3 days a week to protect yourself from burnout and depression etc. Of course it really IS about childcare for some! But often like me, the reality is that I’d have happily worked full time from when my son was about age 5-8 or so, IF I could guarantee that I’d generally be able to leave on time and not come home in tears and end up burning out due to the intensity of the working day. Childcare/single parenting has been a convenient “excuse” for part time working that I can no longer hide behind now he is 18! Fortunately most other GPs fully understand.
And yes GP surgeries are paid an absolute pittance per patient to run the services they do, an average of £164 per patient per year all-in to cover all costs. Less than 10 percent of the NHS budget goes to primary care services, despite more and more issues being diverted from hospitals into the community as a matter of policy. I think most people would assume we get a lot more of the NHs budget than we do. Lobby your MP on our behalf!