Single-handed or group practice, quality of care and patient satisfaction

The Royal College of General Practitioners recently produced a profile of general medical practices in the UK.¹ This stated that there are currently about 10 500 practices in the UK with an average list size of 6000 patients. Of all practices in the UK, 22% were single-handed in 2004. The paper also illustrated the accelerating trend towards multi-partner practices in the UK. In 1991, practices with two or more partners comprised 68% of all practices in England and Wales; by 2004, they had increased to 77% of the total.

What implications have these changes in practice structure for patients in the UK? The Fifth Report of the Shipman Inquiry notes that a review of the literature over the last 10 years suggests that there is no definitive evidence that the clinical performance of single-handed GPs is inferior to that of their colleagues in group practice.² It adds that it seems that no single type of GP practice can claim a monopoly over high quality clinical care³ and that there is no association between the size of a practice and the quality of care that it provides.⁴ However, it mentions that there is a large weight of evidence to suggest that patients favour single-handed or small practices. It reports a 1995 study,⁵ which provided evidence that patients prefer smaller practices, practices with personal list systems and non-training practices. A later study confirmed this finding; smaller practices were seen as being more accessible and achieved higher levels of patient satisfaction.³ Therefore, the implication is that the increasing size of practices in the UK may lead to reduced patient satisfaction.