Does GP practice size matter? GP practice size and the quality of primary care

Document type
Institute for Fiscal Studies
Date of publication
27 November 2014
IFS report; R101
Health Services
Social welfare
Material type

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This report examines trends in the organisation of general practitioner (GP) practices in England between 2004 and 2010, and the relationship between practice size and two indicators of the quality of care. These are Quality and Outcomes Framework (QOF) scores; emergency inpatient admissions for ambulatory care sensitive (ACS) conditions.It also examines the relationship between practice size and outpatient referral behaviour.

Using data from 2010/11, all three indicators of quality that were examined showed that smaller practices are associated with poorer quality in primary care services. The precise nature and size of this relationship vary across the different measures.  There is a small, positive association between QOF scores and practice size. Single-handed practices have the lowest average (mean) QOF scores, while large practices (with more than six FTE GPs) achieve the highest average scores.For ACS admissions, there is some evidence that smaller practices perform worse, on average, than larger practices and are more likely to be among the worst performing. This precise relationship differs across different conditions. Across all the conditions studied, practices with more than six FTE GPs have lower admission rates on average than smaller practices. In the case of chronic conditions, single-handed practices are most likely to be among the poorest-performing practices. Practices with three or fewer FTE GPs are less likely to refer their patients for secondary care than larger practices. Single-handed practices are also less likely than larger practices to refer patients for treatment by independent sector providers (ISPs).

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