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Warning on low quality asthma prescribing

I agree with Dr Sue Love in her stand against super-surgeries (News, May 7). My wife and I moved from our group practices to work together as a job-share one WTE partner in rural Wiltshire two years ago.

We have now experienced small practice medicine after 10 years in practices with 5,400 and 9,000 patients. We are now able to offer our patients accessibility (we see everyone who rings up during surgery times during that surgery and offer pre-bookable appointments for months ahead), quality (we achieved maximum QOF points and are under our indicative prescribing budget by 3 per cent) and continuity (patients see one of the two of us and we only use the same two locums for leave periods).

We are also involved with the PCT and various national collaboratives. We could do none of these to the same level in our previous practices. This is not because they were of poor quality; they were not. This was purely a consequence of their size.

The greatest challenge in our previous practices was to provide continuity of care. With all the changes in primary care since 1990 this seems to have been forgotten. New GPs infrequently mention it. This may be a consequence of little experience.

Patients being looked after by the same small firm of doctors throughout their hospital stay is a rarity. This is a great shame as the long-term relationship between GP and patient is a very cost-effective and time-efficient way of delivering care. It is also greatly valued by patients. Colleagues in small practices bordering super-surgeries tell me they have numerous patients joining their list fed up with seeing a different health care professional at each contact.

It may be true that small practices can practise particularly bad medicine. However, the changes in primary care make this easier to detect and implement improvement plans.

Our personal experience shows it is only in a small practice that the very best general practice can be achieved. The challenge for small practices is to continue making it clear that they are viable and are what our patients want.

In a patient-centered NHS small practices, or larger surgeries delivering care as a group of small teams making continuity a priority, should be the preferred model of primary care.

Dr Patrick Craig-McFeely

Dr Sally Hayes

Hindon, Salisbury

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