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At the heart of general practice since 1960

Smaller practices have fewer unplanned admissions, study finds

Small or single-handed GP practices have 33% fewer avoidable unplanned admissions than practices with 10 to 19 doctors, raising questions over increasing trends towards larger practices, a study has found.

The US study by the Commonwealth Fund - who recently ranked the NHS number one out of 11 nations’ health systems – also found that medium sized practices with three to nine doctors had 27% fewer hospital admissions than bigger practices.

The study looked at 1,045 US primary care practices and found that electronic prescribing and other features common in the largest practices had no impact on lowering unplanned admissions.

It also found significantly lower admission rates in practices owned by the doctors.

The report states: ‘It is often assumed that larger practices provide better care, although there is little evidence to support this, and the majority of U.S. office-based physicians work in practices with fewer than seven physicians.’

‘Rates of preventable hospital admission for patients in primary care practices with one to nine physicians are as much as one-third lower than rates for patients in practices of 10 to 19 physicians. Small practices would benefit from policies enabling them to share resources needed to improve quality of care.’

Pulse reported last month that single-handed practices were increasingly looking to merge in order to stay afloat in the current financial climate, and last year the then RCGP chair Clare Gerada warned single-handers would not survive.

Readers' comments (22)

  • Hazel Drury

    Another study demonstrating the defecation pattern of bears I see.

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  • Fewer unplanned admissions - a revelation indeed.
    So why are we considered unfit for purpose and being herded into federating, grouping or being pushed to liquidation? It's always been an open secret that the continuity of care provided by single handed GPs has been commendable. We do not however fit into that corporate plan the government envisages and giving Contracts to private providers can be a more lucrative investment as some may even receive paybacks. It will cost the taxpayer more but who cares. NHSE and Trust officals can retire to become Directors of local providers and get hefty pay packets. We've had a brilliant example of a former medical director of a London Trust working for an APMS as a Commercial Director.
    What would do you get with investing in single-handed honest practices?

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  • Dr Juneja is entirely correct.
    Time and again we see that small practices offer the continuity (and dare I say-access) that patients (the actual frail and disabled) value. Time and again we see studies that they offer high quality, however they don't fit the political vision-how can "Intermed PLC" make money in our model of care??

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  • Hazel Drury

    What we need is some sort of single handed practitioners federation.... hmm

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  • Hazel Drury

    Sanjeev, it says you are a partner there. How can you be a partner if you are single handed? (Apologies for being pedantic but I have never understood how Pulse don't accommodate us with a proper descriptive title!) :-P

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  • firstly its not only about avoidable admissions

    1-2GP practices do not offer broader coverage:
    we have 6 partner surgery:
    1st partner's role: finance, anticoag, rheumatology
    2nd partner: diabetes and CHD, IT, save guarding
    3rd partner: minor ops, dermatology (has a diploma)
    4th partner: women health, respiratory med
    5th: prescribing, dementia and MH.
    6th: new partner
    each partner has taken roles and they really look at best practice possible and try to provide it. we also initiate inj therapies for diabetes, do lots of minor ops, run sphere clinics.
    how does a single handed GP give adequate attention to all chr illnesses, provide the extras eg minor ops, anticoag: these pts may get 'electively' referred for services which can be given in medium size practice. I am against too big practice as even medium size practices can struggle to give continuity of care. need a balance

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  • Of course what might happen is a we just take on a larger range of jobs. We're a 2 partner practice we initiate diabetes injectables, do minor ops, joint injections womens health (ok not coils but other practices locally do do so). We all have to do finance and safeguarding and IT. What I see in larger practices is less Generalisation, more specialisation and more inefficiencies as more appointments seem required per GP as patients get different messages/Doctor hop.

    I think best size is 6-9k patients eith 3-4 GPs

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  • Russell Thorpe

    At 6.00pm So Doc 1 ref to 3 and 2 to 4 and 5 to 1 etc all the while 6 doing all the work and when 2 goes on holiday all CHD piles up etc really eficient service. Oh and with 6 weeks holiday and perhaps 1 week study leave likely no locum cover so always 1 doc down. My vision for primary care would be GP's responsible for an individual list of 2K pts perhaps working out of the new builds. Best of both worlds and no room to hide for the lazy, inefectual, poorly practitioners. Lets get the job satisfaction back.

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  • I am sorry but general practice is about getting to know the pt, not being a some kind of mini half way specialist who knows bugger all about the pt. this is the problem really, that's why it's called "general" and the reason why the who promotes investment in primary care world wide, as the total saving you make is very good in the overall health economy with better outcomes,

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  • Gaurav Tewary

    Russell Thorpe- this is effectively what happens in Australia. We work as independent Drs under one roof- the roof maybe big or large but we are still independent and more or less have our own list of patients. It really is best of both worlds as other Drs' performance, time keeping etc have no impact on you or your income. But this I feel is only possible in a fee for service system. Best wishes.

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