Practice size and service provision in primary care: an observational study

Abstract

In 2004, primary care payments for basic services and enhanced services were separated. This change has greatly facilitated the evaluation of the breadth and volume of services. AimTo determine whether larger practices produce a higher volume and greater diversity of enhanced services. Design of studyCross-sectional observational study using practice data obtained under the Freedom of Information Act 2000. SettingA total of 384 practices in 14 English primary care trusts. MethodPractice data for all practices were collated for enhanced services, practice size, and deprivation. Diversity and volume of enhanced services were used as dependent variables in a series of multiple regression models to ascertain the effect of practice size, and any relationship with deprivation. ResultsLarger practices provided a greater diversity of services (P = 0.002), although this effect was not present in practices with more than 6330 patients. Practice size seems to influence the volume of enhanced services in general medical services, but this effect disappeared when deprivation was taken into account. Deprivation had a negative influence on the volume of enhanced services provided (P = 0.019). The effect of deprivation on volume persisted in practices with more than 6330 patients. ConclusionCurrent average-sized practices provide similar volume and diversity of enhanced services as those in the largest quartile; therefore, there seems to be little merit in creating 'supersurgeries' if the aim is to transfer work from secondary to primary care. There does not seem to be an upper threshold above which practice size creates spare capacity and expertise to deliver a significantly greater volume or more diversity of extra services.

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“…7,13,[29][30][31] However, the results of the present study did not support this effect of larger practice size. The practice sample size per country of up to 36, and controlling for country, made it difficult to reach significance.…”

Cardiovascular risk management in patients with coronary heart disease in primary care: variation across countries and practices. An observational study based on quality indicators

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“…This is challenging as high quality chronic care asks for an organizational structure allowing for population-based management. In previous research larger practice size tented to be related to higher quality of care considering various conditions with greater diversity of services [1-5]. Furthermore, larger practices tended to show more features consistent with the delivery of chronic care [6,7].…”

Are ‘polysystems’ for doctors or patients?

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