Lone GPs 'not underperforming'

Different types of GP practice were compared

Doctors who work on their own are as good as colleagues who work in group surgeries, says a study in the British Medical Journal.

The BMJ study, carried out by GP academics at Nottingham University, uses measures such as hospital admissions, health prevention targets and teenage pregnancy rates to compare single-handed and group practices.

Patients have consistently said they like single-handed GPs, and the continuity of care they can provide.

But after single-handed GP Dr Harold Shipman was convicted of the murder of 15 patients, questions were raised about the scrutiny of solo GPs.

We have found no evidence that single-handed GPs are underperforming clinically

Dr Julia Hippisley-Cox said:

In the NHS Plan, published last year, the government said it was concerned single-handed GPs were professionally isolated and of a poorer quality than those who worked in groups.

It suggested new contractual arrangements for single-handed GPs and said if negotiated change was not possible, all single-handed practices would be transferred by 2004.

Writing in the BMJ, lead researcher Dr Julia Hippisley-Cox said: "We have found no evidence that single-handed GPs are underperforming clinically."

Measures

The researchers looked at 206 single-handed practices and 606 GP partnerships across the Trent region. Of 4.9m patients registered with practices in the region, 9.7% are registered with single-handed GPs.

They looked factors such as which practices achieved targets set for cervical smears and childhood immunisations and hospital admissions.

When the basic statistics were looked at, single-handed practices fared worse.

But when factors such as deprivation, and the background and age of the population the practice were examined, "no substantial differences" could be seen between the two types of practice.

The percentage of Asian and black residents, men and women over 75 and how rural the area was were also looked at.

Most single-handed GPs were older than their colleagues in partnerships, and had more people on their lists.

Evidence

Dr Hippisley-Cox told BBC News Online: "There are differences between single-handed GPs and partnership practices, but not because of the doctor - because of the area.

"This research was an objective attempt to provide evidence in an evidence-free zone."

She added: "If there's going to be a major change to how single-handed GPs are working, it needs to be based on evidence."

Dr Michael Taylor, chairman of the Small Practices Association said the research confirmed single-handed provided as high a standard of service as GPs in group practice - and said his members needed the morale boost this research provided.

"The number of small practices is falling, and it is falling as a result of government pressure and health authority pressure, and as a result of single-handed practices not being advertised as such, and this is despite the fact that patients prefer it and say that's what they want."