Nobody at the practice believed ten minutes was enough. Since nobody could make it longer, they asked a narrower question: what are ten minutes best spent on?
The referral letter was rewritten to lead with the question rather than the history, which cut a round of clarification out of most onward pathways.
The practice runs a flag on anyone presenting three times with the same complaint and no diagnosis, regardless of what was concluded each time.
Most of a consultation is reconstruction. If the reconstruction is already done, you get the ten minutes back.
Illustrative composite
Continuity was measured for a year: what proportion of appointments a patient had with the clinician who knew them. It had fallen to under a third.
“I arrive and she’s already read it,” Della says. “So we start at the actual thing.”
