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Study: GP practice expansions have led to poorer continuity of care


practice closed


GP practices that have grown in size over the last few years have been less able to accommodate patients in seeing their preferred GP, a study has concluded. 

The research, led by the University of Kent, and published in the BJGP, analysed UK GP Patient Survey responses  between 2013 and 2018 to track reported changes in access to care.

It found that in 644 practices that expanded by more than 20% during this period, the proportion of patients who said they were able to see their preferred GP fell by 10% (from 59% to 49%). 

Meanwhile, in the 5,602 practices that experienced less change in size, this fell by 7% (from 63% to 56%), the study found. 

The report said the fall remained greater in practices that had expanded, even after allowing for other characteristics, such as age distribution of the registered patients, rurality and level of poverty.

The English practices that have expanded have not achieved better access to care or provided better overall experience, the researchers concluded. 

This is despite the UK Government encouraging ‘expansion, mergers and greater collaboration between practices’, in order to deliver services ‘more efficiently’ and to lengthen opening hours, they said. 

According to the report, ‘being able to see the same GP is highly valued by many patients and previous studies have suggested that it may lead to fewer hospital admissions and fewer deaths’. 

Professor Forbes, research lead, commented: ‘Larger general practice size in England may well be associated with slightly poorer continuity of care and may not improve patient access. This goes to show that bigger may not be better with English primary care.

‘Better health outcomes for individuals and patient experience for those with long-term conditions must be prioritised. Continuity of care is an important feature of good quality primary care and it is vital that we preserve this for the benefit of patients. It is also important that we collect good data about collaborative working and practice growth and monitor the effects on patient experience.’

Patient satisfaction with general practice has stayed relatively high overall in 2020, according to the latest UK GP Patient Survey, despite the impact of Covid-19 on demand and workload pressures.

But almost 100 GP practices closed in the UK in 2019, recent figures collected by Pulse showed – as GPs warned Covid-19 could prompt even more to shut this year.

A version of this article was first published by Pulse sister title Healthcare Leader