Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England.

Autor:	Holdroyd I; Foundation Doctor, School of Clinical Medicine, University of Cambridge, Cambridge, UK., Chadwick W; Foundation Doctor, School of Clinical Medicine, University of Cambridge, Cambridge, UK., Harvey-Sullivan A; Academic Clinical Fellow, Wolfson Institute for Population Health, Queen Mary University of London, London, UK., Bartholomew T; GP Registrar, General Practice, Royal Surrey NHS Foundation Trust, Guildford, UK., Massou E; Research Associate, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK., Tzortziou Brown V; Senior Clinical Lecturer, Wolfson Institute for Population Health, Queen Mary University of London, London, UK., Ford J; Senior Clinical Lecturer in Health Equity, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Jazyk:	angličtina
Zdroj:	Journal of health services research & policy [J Health Serv Res Policy] 2024 Jul; Vol. 29 (3), pp. 201-209. Date of Electronic Publication: 2023 Dec 13.
DOI:	10.1177/13558196231218830
Abstrakt:	Objectives: As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. Methods: Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. Results: Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. Conclusions: We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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