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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.