Patients want to be better informed and GPs want more time to discuss treatment options with them

Dr Hamish Meldrum, British Medical Association

The rest of their salaries are made up by a complex system of fees and allowances and payments for reaching certain targets, such as immunising children.

But the BMA has said that combining these into a single payment would enable them to spend more time with patients.

This would be achieved by allowing GPs to cut the number of patients registered with them while at the same time not losing out on their salaries.

GPs earn an average of �54,220 per year, although many earn much more.

However, this would require a significant increase in the number of GPs.

The government has pledged to boost the number of GPs working in the NHS by 2,000 by 2010.

However, the plans to increase consultation times may run into problems as a result of the government's pledge to require GPs to see all patients within 48 hours by 2004.

If patients are being seen for 15 minutes at a time, the number of appointments each day would be likely to fall sharply.

Improve treatment

Dr Hamish Meldrum, joint deputy chairman of the GPs committee of the British Medical Association, said the changes would improve treatment for patients.

"On average, a family doctor carries out 10,000 patient consultations a year.

"With large numbers of patients on their lists GPs cannot spend long enough to offer the quality service both patients and doctors want."

Dr Meldrum: Longer consultations benefit patients

He said that there was clinical evidence to support longer consultations.

"Patients want to be better informed and GPs want more time to discuss treatment options with them, particularly as medicine is becoming increasingly complicated.

"We believe that a 15 minute consultation is the current target to aim for, although there will always be some patients who need longer than that.

"There is good clinical evidence that longer consultations will allow us to do that, but if we are to meet all the targets the government is setting us we need far more GPs, and more nurses," he added.

The issue of patient consultations is one of a number of proposals put forward by the BMA in a discussion document on how GPs should be paid in future.

A Department of Health spokesman said providing patients with sufficient consultation time was a top priority for the government.

He said: "The key to delivering this in primary care is to encourage and support GPs who design their services around individual patient needs rather than the traditional, sometimes rigid, methodology of organising clinic and surgery opening times at the convenience of the practitioner rather than the patient.

"The Government is currently spending approximately �5 million a year through the National Primary Care Development team to support them in working with their practices to achieve these objectives."

The document has been sent out to GPs for consultation.