Do single handed practices offer poorer care? Cross sectional survey of processes and outcomes
Hippisley-Cox J., Pringle M., Coupland C., Hammersley V., Wilson A.
Objectives: To determine whether there are important differences in performance between group practices and singlehanded general practitioners and the extent to which any differences are explained by practice characteristics such as deprivation. Design: Cross sectional survey. Setting: 206 singlehanded practices and 606 partnerships in Trent region, United Kingdom. Method: Comparison of process and outcome measures derived from routinely collected data on hospital admissions and target payments for singlehanded practices and partnerships. Multivariate analysis was used to adjust for the confounding effects of general practice characteristics—deprivation (Townsend score), percentage of Asian residents, percentage of black residents, proportion of men over 75 years, proportion of women over 75 years, rurality, presence of a female general practitioner, and vocational training status. Results: Differences in achievement of immunisation and cytology targets apparent on univariate analysis were not seen after adjustment for other general practice characteristics. Similarly, significant differences (>15%; P<0.01) for three types of hospital admission seen on univariate analysis were not present after adjustment for other practice characteristics. Conclusions: This study provides no evidence that singlehanded general practitioners are underperforming clinically. Our results offer insight into the structural difference between the two types of practice and underline the importance of the effect of other practice characteristics on process and outcome measures. Singlehanded general practitioners tend to work in areas of high deprivation and need Patients like singlehanded practices because of good communication, personal rapport, availability, and continuity of care Concerns have been expressed about professional isolation and quality standards for singlehanded practice, on the basis of little evidence This study provides no evidence that singlehanded general practitioners are underperforming clinically The results offer insight into the structural differences between the two types of practice and underline the importance of other practice characteristics such as deprivation. © 2001, BMJ Publishing Group Ltd. All rights reserved.