So much has been staked on the promised land of “General Practice at scale” that I always look out for new reports on the evidence. It has moved me to do my own research too.
Nuffield Trust published their latest review on Large Scale GP in England last week. Plough through 47 pages if you have time but this is from the conclusions:
“…well placed to improve safety and quality processes, but pointed to unintended consequences affecting workforce turnover and continuity of care. The views of patients regarding the impact of new forms of largescale general practice collaborations are largely unknown.”
I love unknowns. So I decided to look at how patient satisfaction is affected by practice list size, and if you know where to look it’s not too difficult to find data, using the GP Patient Experience Survey (not my favourite dataset but the best we have.)
The results were as clear as they were surprising, and I presented them last week at the European Forum for Primary Care. It’s a good crowd, bringing together people who care about strong PC with fascinating diversity across both professional groups and nationality. The poster:
Let’s look humbly at the data – I have no axe to grind or misty-eyed nostalgia for smallness – it’s a matter of what’s appropriate. (My early career was in Rolls-Royce plc, a company of thousands because making aero-engines most definitely is not a cottage industry.)
So here’s what we know: patients value continuity of care. It’s possible at any size, but harder to achieve in large units.
The real crime of policy makers is to distract our attention with size, scale and structure when transformation is so quickly and cheaply achieved by simple, sustainable means.
When will they ever learn?
Founder, Chief Executive, GP Access Ltd
PS 2015 study, “How does practice list size affect secondary care costs?”
And this is fascinating, expenses are actually higher per patient in larger practices!