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.
- © British Journal of General Practice, 2006.