GP - single-handed GP practices
March 2008
Single-handed general practitioners, like other GPs in partnership, are committed to delivering high quality care to their patients. Single-handers currently care for approximately five million patients and do so with high continuity and accessibility. Indeed, their patient satisfaction ratings have remained consistently high, particularly since they offer such a personal service.
In 2006 there were 1,717 Single Handed Practitioners out of a total of 27,691 GP providers (see reference 1).
The research evidence demonstrates that single-handed GPs provide a high quality service (see reference 2). Patients prefer small practices and practices that have personal list systems (see reference 3.) High quality in general practice is associated with smaller overall practice list sizes (see reference 4 ). Personal, continuous care (as is provided in single-handed practices) is linked with patient satisfaction (see reference 5).
An Audit Commission report (see reference 6) in 2002 stated that ‘access to care, continuity of care and some aspects of communication tend to be better in smaller practices’. The report also quotes evidence that 'no practice type has a monopoly on quality of care' (see reference 7) and concluded ‘there are therefore good arguments for preserving a diversity of practice sizes and types. … One challenge is to ensure that the trend towards larger practices does not mean that patients lose out on some of the advantages that smaller practices currently offer.’
In the framework document for the General Medical Services (GMS) Contract, agreed by Health Ministers in all four countries of the UK in 2004, it stated that the contract 'will allow GPs in small practices to continue as before, but with the opportunity and the incentive to demonstrate that they can provide high quality care and be rewarded appropriately' (see reference 8).
This has been borne out despite that fact that the absence of any consideration for diseconomies of scale in the allocation formula tends to disadvantage smaller practices.
Since implementation of the GMS Contract in 2004, there has not been any significant impact on single handed practices. The review of the GMS formula is still underway and will be implemented from April 2007. Diseconomies of scales are being review as part of these discussions.
Single-handed practitioners recognise that they must, like all general practitioners, be accountable for the service they provide and open to scrutiny. They also recognise that appraisal and revalidation have been introduced and that this will help to assure the quality of care they deliver.
For further information, please contact the parliamentary unit:
Email: parliamentaryunit@bma.org.uk.
- Source: The Information Centre for health and social care General and Personal Medical Services Statistics 1996-2006
(A Single Handed Practitioner (excluding GP registrars and GP retainers) has no partners although may employ a GP registrar or GP retainer) - Hippisley-Cox J, Pringle MAL, Coupland C, Hammersley V, Wilson A. Do single handed practices offer poorer care?: Cross sectional survey of processes and outcomes. BMJ 2001;323:320-323.
- Baker R, Streatfield J. What type of general practice do patients prefer?: Exploration of practice characteristics influencing patient satisfaction. BJGP 1995;45:654-659.
- Howie JG, Heaney DJ, Maxwell M, Walker JJ, Freeman GK. Developing a ‘consultation quality index’ (CQI) for use in general practice. Family Practice 2000;17(6):455-61
- Hjortdahl P, Lærum E. Continuity of care in general practice: effect on patient satisfaction BMJ 1992;304:1287-90.
- Audit Commission. A Focus On General practice in England. London; Audit Commission, 2002.
- Campbell SM, Hann M, Jacker J, Burns C, Oliver D, Thapar A, Mead N, Gelb Safran D, Roland M. Identifying predictors of high quality care in English general practice: observational study. BMJ 2001;323:784-787.
- General Practitioners Committee. Your contract Your Future. London; British Medical Association, 2001.