Increased size of GP clinics produces no discernible gains in patient care, a new UK report suggests
Bigger is not necessarily better when it comes to GP clinics, with no discernible gains in patient care found due to increased size, a new UK report suggests
An analysis by The Nuffield Trust, in collaboration with Britain’s RCGP, looked at how eight large-scale organisations fared on 15 indicators of quality over 15 months.
“We were unable to detect marked differences in the quality of the large-scale general practice organisations compared to the national average – most organisations followed national trends,” the authors wrote.
The UK study also revealed that patient satisfaction had deteriorated over time in large GP clinics, a trend mirrored by clinics of all sizes.
Some patients in the study voiced concerns about losing the ongoing, trusted relationship with their own GP and their own practice, while others valued new forms of access.
But increasing the size of practices did improve the efficiency of the business through the centralisation of management and administration and maximisation of income.
Similar results to the UK report have also been reflected in Australian studies, Professor Mark Harris, from the Centre for Primary Health Care, told The Medical Republic.
“We have previously conducted research which showed that patient experience and quality of care was not necessarily better with increased size of practice,” he said.
But Australia had not seen the same level of large-scale collaborations between practices of the type described in the UK study, Professor Harris said.
However, Australia did have corporate general practice chains and it was possible that large-scale collaborations could emerge in the future.
“But it would require some active government policy to bring this about,” Professor Harris said.
The size of GP clinics has been increasing in Australia in recent years. More than half of GPs worked in practices with five or more doctors in 2006-07, representing an increase of 20% over six years, according to BEACH data.
Professor Harris told The Medical Republic that the improved efficiencies possible in larger practices had to be weighed against the increased complexity of inter-professional collaboration and a possible loss of personal continuity of care.
“This is not inevitable with larger practices, but it does require work to create functional teams and ensure continuity of care,” he said.
In the UK study, staff were mostly positive about working in large-scale organisations, valuing the education and training opportunities and peer-support arrangements.
Administrators and receptionists reported the highest overall satisfaction scores and salaried GPs reported the lowest.
