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Does practice size really matter?

I have recently been pondering writing a series of articles or posts about 'what size of practice is most efficient'.

I thought of this after the comments made by NHS England's deputy medical director last year that the GP partnership model would disappear within a decade. His view was that primary care needed to be provided 'at scale' by larger organisations.

The truth is I have both good and bad (maybe I should say effective and ineffective) practices of all sizes. I saw a single handed GP just before Christmas who has 3,000 patients, shares costs with other single-handed practices in the same building, employs almost no extra clinical help and makes above average profits. His patients are content – he knows them all and it is an efficient model.

The super-practices have other issues, and patient experience depends on personal lists or shared lists. Larger practices often have more emergencies to deal with by a range of clincians.

A practice recently highlighted in a Daily Mail article because patients queue outside from 6.30am to get a same day appointment is a client of mine, with a large list.

I also saw them before Christmas. I stood behind an elderly lady moaning and complaining that she needed to be seen as an emergency immediately because her son who brought her in needed to go to work. What you gain with large practice efficiencies you lose in other ways. Maybe his could be a way of opening up the discussion?

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