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At the heart of general practice since 1960

Number of single-handed practices has halved in seven years, study finds

The number of GP practices with only a single partner has halved since 2006, while the number of practices with ten or more doctors grew by over 75%, a new report investigating the general practice crisis has found.

A Nuffield Trust analysis of official data showed that there were 1,717 single-handed practices in 2006, but only 891 in 2013, while more than three quarters (77%) of health and social care leaders surveyed by the think-tank said small GP practices are ‘no longer fit for purpose’.

The report, titled Is General Practice in Crisis?, concluded that ‘general practice is under great pressure from falling funding, workforce problems, and the growing needs and rising expectations of an older, sicker population’.

The Nuffield Trust suggested that a solution is for GP practices to ‘move away from the traditional model of small, free-standing general practices, towards larger GP organisations or networks’.

The report said: ‘Collaborating in this way allows GPs to pool resources and increase scale, improving their ability to invest in staff and infrastructure, and build links with the wider health system and take on new and extended clinical and managerial roles. This does not mean that the familiarity of local practices need be lost. Network structures can allow the advantages of scale while keeping their neighbourhood presence.’

It further suggested these larger practices should keep separate lists for patients with different needs so that for example frail elderly or homeless people could attend practices employing specialists in other relevant fields such as geriatricians or mental health workers.

Other solutions suggested included handing a larger share of the NHS budget to general practice and for politicians to reduce public ‘criticism and confrontation’ with GPs.

However, GPC chair Dr Chaand Nagpaul said patients still value the ‘flexible and local approach’ delivered by smaller GP practices.

He said: ‘While one response to these pressures is for practices to get bigger, or increasingly work together in groups, we must not lose the flexible and local approach delivered by many smaller practices that is so valued by many patients. Fundamentally, we need policy makers to properly support and invest in general practice so that it has the ability to deliver the care that patients deserve.’

Readers' comments (5)

  • In order to preserve local personal care and choice small practices are forced to go under to make way for larger (less personal) out of reach (not locally based) practices.

    Orwell would be proud.

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  • There's a difference between smaller and single handed. I do think that single handed practices suffer from a significant number of disadvantages compared to smaller practices of say up to 4/5 GPs and there's probably good reason to try and merge. Not keen on overly large federations though as those suffer inefficiencies of their own.

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  • I'm a single handed doc and would love to merge with other practices. Problem is there is no political will in our local health board (for I am in Wales). Also we serve strung out sparsely populated areas so a merger would mean lots of traveling in an area with poor public transport infrastructure.

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  • as a single handed i had 3500 patients. offered anticoagulation minor surgery family planning, extended hours .teaching medical students,. had two practice nurse . p/manager/ 3 receptionists HCA. data clarke . very nice new premises near 100% qof and all patients rated us as 5 star service and we made excellent profit (nearly twice national average. ) patients loved our services.
    some one telling "not fit for purpose" ..

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  • FDA Advises Caution When Interpreting the Findings of the Nuffield Report On Future Of General Practice

    While welcoming the recognition of the crisis in general practice, the Family Doctor Association urges politicians to be cautious before accepting all of the findings of the latest report from the Nuffield Trust called ‘Is General Practice in Crisis?’

    The recommendations on the future of general practice were drawn from a panel of 100 “NHS and Clinical Leaders”, 75% of whom responded to the survey. Most were managers in acute hospital trusts, ambulance trusts, mental health trusts and the third sector with a tiny proportion working in CCGs, of whom there were even fewer actively working in general practice. This is rather like asking a group of GPs how to run a renal unit.

    The recommendations of the report mirror Simon Stephens’ recent Five Year Forward View, an excellent review of the health service by the CEO of NHSE.

    The Nuffield report does recognise the demographic time bomb in the GP population with so many active GPs being over the age of 55 and looking to retirement and so few being trained to take their places.

    The Association welcomes the suggestion that practices should have pump-priming money to facilitate co-operation between practices. However it seriously disagrees with the implied premise that “bigger is better” and that “working at scale” is the only future for general practice.

    Maintenance of Continuity of Care is essential for patients and this is best met in smaller general practices, which may, of course, share a lot of their backroom functions.

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