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Patient satisfaction is higher at smaller practices

From an anonymous member of SPACE (Small Practices Academy of Clinical Excellence) in Southend-on-Sea, Essex

In January MORI published the results of its latest patient satisfaction survey. For Southend-on-Sea, a south Essex borough with a population of 178,000, and the town in which my small GP practice is situated, the figures make very interesting reading.

There seems to be a policy (unstated) at NHS England to squeeze out smaller practices

Satisfaction among Southend’s 34 practices ranged from 97% to 57%, and 12 practices had a rating below 85%. Of the 19 practices with a rating of 87% and above, 18 were small practices. The worst-rated practice, with just 57% satisfaction, was a large multi-partner practice. In other words, the survey reveals patient satisfaction to be greater among small than among large practices.

Unfortunately, there seems to be a policy (unstated) at NHS England to squeeze out smaller practices in favour of large practices despite the excellent quality of care they provide. In pursuance of this policy investment of scarce resources continues to be concentrated on innovation and large practices, to the detriment of small practices. But the Southend patient satisfaction ratings reveal the policy and funding inequalities to be misguided, and point to the need for a reassessment.

Perhaps the biggest threat to small practices is from the CQC which is extremely demoralising and seems to be weighted against small practices. This occurs at a considerable cost to the taxpayers as well as the provider service of the health system, and does not improve quality.

Secretary of State Jeremy Hunt has publicly declared his support for continuity of care and dedicated named GPs for all frail and elderly patients. It is surely a matter of regret that his views do not seem to be shared by top NHS managers, nor, it seems do they have the support of the BMA, GPC, LMC and RCGP.

I end with a plea for NHS England and the Department of Health to provide a structure that values and supports equally all patients irrespective of their age and treatment, whether it be in a large or small infrastructure.

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Readers' comments (5)

  • Totally true - a timely article. It is an ongoing and perhaps impossible task to ensure any real continuity of care in a large practice - it is effortless and natural in smaller practices.

    Why oh why, is this obvious fact completely ignored as we rush towards larger and larger groups of increasingly impersonal and often badly dissatisfied doctors and patients.

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  • well timed, apposite, waste of time - they're not listening, and don't intend to start, so why waste your breath

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  • Working from a small practice is so much more friendly and personal. We know just about everyone on our list and continuity of care is very easy, I have worked in a larger 12,000 plus before and was asked on my last day of 8 years 'are you new here?' !!!

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  • i worked as single handed. all polls gave me highest satisfacton in whole ccg and in top practices in country.
    continuity of care, friendly atmosphere good access and good clinical care makes small practices popular

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  • This is new evidence but not a new finding. As a rural GP I was involved in trying to get a current senior member of the CQC in his position as RCGP chair to consider that small practices were inevitable in some geographical settings and that the evidence for better quality in larger units was at least patchy. I am now convinced that the suggestions to avoid revisiting practices that provide good data yet have poor results in the patient satisfaction ratings reflect the same attitudes from the same person. Unfortunately these people are driven by dogma not evidence.

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