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Patients in large group practices are less happy with the standard of care they receive than those in smaller surgeries, a survey has concluded.

One in four patients who regularly saw their own GP said standards of care had risen in recent years compared with 17 per cent of patients at group practices.

In contrast, 20 per cent at larger practices said care standards had deteriorated compared with 11 per cent at small practices, according to the YouGov survey for the Daily Telegraph.

Overall, 65 per cent of 'patients with their own GP' rated their doctor's performance as first-class or very good compared with 46 per cent of 'patients in a group practice'. Dissatisfaction with group pract- ices was higher in urban areas.

GPs in group practices rejected the findings. They said standards of care were increasing everywhere and patients were still able to see the doctor of their choice.

Dr Nick Whitehead, whose practice in Frome, Somerset, has 30,000 patients and 22 GPs, said patients had 'learned to play the game' and would either wait to see him or see another GP or nurse if the problem was urgent.

He said: 'There is a spectrum of patients who would consider they don't have continuity of care but most people are happy and I would refute that quality of care in group practices has deteriorated.'

Dr David Jenner, a GP in a 10-partner practice in Cullompton, Devon, said patients with chronic diseases tended to see the same partner while those with minor illness do not mind who they saw.

The survey did not recognise the choice of practitioner group practices can give patients or the greater flexibility in appointments, he added.

Singlehanded GPs said group practices found it harder to offer the same continuity of care. Dr Ian Kelham, a singlehander in Porlock, Somerset, who used to work in a group practice, said: 'They are doing other things that are necessary for medical care but [patients'] perception is their doctor is not always available.'

Patient views on GP services

•82 per cent believe GPs should be able to drop 24-hour responsibility

•52 per cent worried the opt-out means it is less likely they will see their own GP out-of-hours

•56 per cent feel they know their own GP very or fairly well

•54 per cent think their GP knows them very or fairly well

•94 per cent know their GP's name

•47 per cent say their GP knows their name without having to check their notes

By Ian Cameron

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