News Release

Larger GP practices do not provide better care

Association between practice size and quality of care of patients with ischaemic heart disease: cross sectional study BMJ Volume 326, pp 371-2

Peer-Reviewed Publication

BMJ

It is widely known that fewer patients die in larger hospitals that do more operations, but does a similar association between volume of treatment and quality exist in primary care? In this week's BMJ, Azeem Majeed and colleagues set out to test whether large general practices or those that treat more people provide better care.

They identified patients with ischaemic heart disease in 62 general practices in southwest London. Practice size varied from 1,265 to 13,147 patients. In total, 6,888 people had ischaemic heart disease. The number of cases in individual practices varied from 12 to 326.

Only recording of cholesterol concentrations showed an improvement with increasing number of cases of ischaemic heart disease. All other aspects of management were not associated with the number of cases managed. They also found no association between practice size and the quality of care.

This suggests that the trend in the NHS towards larger general practices by itself has little impact on the quality of chronic disease management in primary care, say the authors.

Although recent developments in the NHS have cast doubt on the future of smaller practices, both patients and the doctors seem happy with smaller practices. Smaller practices are often seen as more accessible and achieve higher levels of patient satisfaction.

The NHS should reconsider how it can improve the quality of care provided by general practitioners, without relying on the presumed benefits of consolidating them into larger units, they conclude.

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