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Is bigger better for general practice?

I remember my son Matthew asking me when he was very young which was stronger, a lion or a tiger? Another popular topic was whether a shark could win a fight with a Tyrannosaurus rex.

I am sure we all have memories of similar questions. My answer tried to explain that the comparison was not valid, before putting my money on the T rex! Which beast was better? Impossible to say.

I completed my chartered accountancy training at a firm called Stoy Hayward, now BDO. They have 3,500 people working in the UK in 19 offices. My own firm, Ramsay Brown and Partners has less than 30. Does that make BDO better than us? No, it makes them different.

I can walk around my office and talk to all my team and know where we are. Running 3,500 people requires a completely different set up.

So it was with interest that I read the Nuffield Trust’s recent Is Bigger Better? Lessons for large-scale general practice. I will leave you to read the detail if you wish, but it is worth quoting the conclusion:

‘Overall: We were unable to detect marked differences in the quality of the large scale general practice organisations compared to the national average  –  most organisations followed national trends. No single organisation consistently outperformed or underperformed the others on all indicators. We also examined the variation in performance in member practices within organisations and similarly found no patterns.’

Just yesterday I visited a client on the south coast. She told me about a five-partner practice locally with around 10,000 patients that merged with an ‘acquiring’ GP organisation with the expectation of reduced workload and stress for the partners. The result was very different and all five partners have resigned and, according to my client, the practice is not what it was.

There is an almost evangelical push for bigger (because it is cheaper?), but it does not necessarily mean better - it means different.

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