By Stephen Robinson, 05 August 2011
Researchers have shown that small practices are not less efficient than larger ones
The findings from researchers at Imperial College, London defy recent tacit pressure from government and PCTs to reduce the number of small practices over fears they are less efficient financially and clinically isolated.
Researchers led by Dr Eszter Vamos said: ?Our data support the view that different types of practices might have different strengths, and no single type of practice has a monopoly on high-quality care.?
Single-handed GPs have faced increased scrutiny in recent years, and numbers fell steadily in the last decade.
Successive governments have pushed for smaller practices to amalgamate, culminating in vast Darzi centres in 2008.
In January 2010, former health secretary Andy Burnham told GP that single-handers were rightfully becoming 'a minority'.
And across England, GP leaders had accused PCTs of pressuring small practices.
In the study, published in the CMAJ, researchers examined data from 422 mixed-size practices, including 154,945 patients.
They compared management of BP, HbA1c levels and total cholesterol of diabetic patients against national treatment targets.
Researchers found that the QOF led to an acceleration of improved management of BP and total cholesterol, although there was no effect on the pace of change with regards to HbA1c levels.
They isolated the effect of practice size on diabetes control from general improvements attributed to the QOF but found no difference between the smallest and largest practices.
The team concluded: ?Our findings are of particular importance at a time when healthcare managers increasingly promote the consolidation of practices into larger units as a means of improving quality of care.?
They advised that decisions to consolidate practices, such as through Darzi centres, should continue to be based on improving access to primary care and service quality.
In 2010, a PCT researcher showed small practices perform better than larger ones, according to the findings of a PCT researcher.
The findings agree with those of PCT researcher Andrew Rouse, a consultant in public health at NHS Heart of Birmingham.
He found small practices perform better in the QOF than larger ones. Mr Rouse warned that local and national policy that favours large practices will result in a ?very unsatisfactory service'.
The findings from researchers at Imperial College, London defy recent tacit pressure from government and PCTs to reduce the number of small practices over fears they are less efficient financially and clinically isolated.
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