Is bigger better – for patients?

This week saw the release of the Nuffield Trust’s study of 4 large GP practice organisations, headed “Is bigger better?”.  The conclusion after 111 pages is roughly that although practices are being nudged in this direction, “we have not been able to provide evidence about improving quality”.

The question arises, why is NHS England nudging on such a lack evidence, but we need to ask specifically, who is looking out for patients?  Nuffield says rather coyly in the summary (p 4) “Patients had mixed views about large scale general practice, identifying more with their own practice than with the overarching organisation” but the meat is on p71 where patient satisfaction indicators are listed.

The patient satisfaction survey is not my favourite metric but this is all we have, comparing 3 large GPs with the national average:

Ease of getting through on the telephone:  2 worse, 1 better

Able to get an appointment:  all 3 worse (one only slightly)

Seeing preferred GP:  all 3 worse

Rating GP for involvement in own care:  all 3 worse.

In 11 out of 12 measures the larger organisations are rated by patients as worse than average.  Something tells me that however you measure this, it’s not even close.

I have no axe to grind on practice size.  We’ve helped all sizes from single handers to tens of thousands.  My beef is with those saying we must have bigger, because, er, because it must be better.

What interests are driving them?  I’ve seen nothing concerned with patient benefit, and Nuffield has laid out the evidence against.  The problems facing patients in getting access to their own GP are well known.  Size and structure are not the answer, but they are an ever absorbing distraction from what we should be doing.

Harry Longman

One response to “Is bigger better – for patients?”

  1. But we must do it at scale, Harry, and NHS England uses “scale” as a synonym for “big and (therefore) efficient”.
    Yours, at pace,

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