Is bigger better? Lessons for large-scale general practice

ROSEN Rebecca, et al
Nuffield Trust
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This report examines factors affecting the development of large-scale general practice organisations in England and their impact on staff, patients and quality of care. It draws on the results of a national survey on collaboration in general practices, and compares and contrasts the experiences of large-scale general practice organisations using in-depth case studies. It also uses 15 quality indicators to describe the impact on the quality of primary care services. The results from the survey showed that three-quarters of practices are now working collaboratively in larger-scale organisations. The main reasons given were to create efficiencies and provided extended primary care services. Findings from the case studies suggest that large-scale general practice organisations can improve the sustainability of general practice and provide extended services in community settings. They are also able to invest in technology and infrastructure which may be beyond smaller organisations. Staff also valued the training and peer support available. However, evidence that large-scale general practice organisations can improve quality of services for patients was mixed. Many patients had concerns that it would become harder to access their own practice and that they would lose their relationship with their usual GP. The report provides recommendations for general practice organisations, policy makers and commissioners about what large scale organisations can achieve and how to create an environment to help then thrive. An additional appendix provides additional details of the case studies. (Edited publisher abstract)

Subject terms:
primary care, community health care, models, joint working, general practitioners, organisational structure, collaboration, case studies, service development;
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