Small but perfectly formed

Released 09/04/2010

by Matt Jane

Suzannah Wright muses on petite practices

This week has been challenging. Not because of the rude return to work after a long weekend, but thanks to a piece of research which questioned the idea that bigger is better for general practice.

A researcher at the Heart of Birmingham PCT found that small practices perform better clinically. Leaving aside questions around whether high QOF scores actually equate to better services overall, it may make an interesting discussion point for a PCT that has been pilloried for it's plans to reduce the number of small and single-handed practices in the area.

Policy makers like large practices because they are more cost-effective, and may provide a wider range of services. They are also likely to have better governance overall but we all know the continuity of care and other benefits which smaller practices can provide. Which is why the RCGP's model of federated practices seems so attractive - gain the efficiency and service provision advantages of a large group of practices, with the clinical benefits of smaller patient lists.

It would be interesting to see more of Rouse's results - the division between practices with under 10,000 and over 20,000 is fairly large and we have no indication yet of how those practices were performing. Likewise, it would be interesting to see how many partners the practices had, and how the partner/patient ration and staff/patient ratios affect performance.

So the research raises many questions and will hopefully prove a challenge to PCTs or DH policy makers who are thinking about how to make primary care and general practice more effective.

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