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small practices

Smaller practices are offering equally high-quality clinical care as their larger counterparts, but need more help in future to keep their good performance going, research concludes.

The study of more than 600 practices in Scotland found smaller practices scored a median of eight points fewer in the organisational domains of the quality framework in its first year, but equally well on the clinical and patient experience sections.

But inconsistencies in data on mortality and disease prevalence indicated that these weaknesses in organisation may be holding smaller practices back, the research by the University of Glasgow reported.

Prevalence of hypertension and CHD were similar across all practices, but mortality for patients under 70 years was 40 per cent greater for singlehanders than larger practices.

The study, published in this month's British Journal of General Practice, concluded this may indicate unmet need among patients of smaller practices.

It concluded: 'Small practices performed as well as larger practices in this first exercise of the QOF, but the suggestion of organisational weaknesses may make it more difficult to repeat this success, for example with larger caseloads of CHD patients, or with more demanding QOF criteria.'

Smaller practices may not be fully maximising their QOF point attainment as a result, it added.

Dr Michael Taylor, chair of the Small Practices Association, and a GP in Heywood, Lancashire, said organisational factors were less important in a small practice.

He said: 'Singlehanded GPs have so much about their patients in their heads. Very often you know each patient so maybe you don't focus on the organisational factors so much.'

Dr Tom Frewin, a singlehanded GP from Bristol, said the results showed GPs could work in different ways to achieve the same clinical outcomes.

Smaller practices had fewer adverse events so did not monitor such statistics, he added.

Earlier research by the National Primary Care Research and Development Centre in Manchester found smaller practices scored marginally more clinical points than larger ones.

small practices

Smaller practices are offering equally high-quality clinical care as their larger counterparts, but need more help in future to keep their good performance going, research concludes.

The study of more than 600 practices in Scotland found smaller practices scored a median of eight points fewer in the organisational domains of the quality framework in its first year, but equally well on the clinical and patient experience sections.

But inconsistencies in data on mortality and disease prevalence indicated that these weaknesses in organisation may be holding smaller practices back, the research by the University of Glasgow reported.

Prevalence of hypertension and CHD were similar across all practices, but mortality for patients under 70 years was 40 per cent greater for singlehanders than larger practices.

The study, published in this month's British Journal of General Practice, concluded this may indicate unmet need among patients of smaller practices.

It concluded: 'Small practices performed as well as larger practices in this first exercise of the QOF, but the suggestion of organisational weaknesses may make it more difficult to repeat this success, for example with larger caseloads of CHD patients, or with more demanding QOF criteria.'

Smaller practices may not be fully maximising their QOF point attainment as a result, it added.

Dr Michael Taylor, chair of the Small Practices Association, and a GP in Heywood, Lancashire, said organisational factors were less important in a small practice.

He said: 'Singlehanded GPs have so much about their patients in their heads. Very often you know each patient so maybe you don't focus on the organisational factors so much.'

Dr Tom Frewin, a singlehanded GP from Bristol, said the results showed GPs could work in different ways to achieve the same clinical outcomes.

Smaller practices had fewer adverse events so did not monitor such statistics, he added.

Earlier research by the National Primary Care Research and Development Centre in Manchester found smaller practices scored marginally more clinical points than larger ones.

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