Julian Bradley wrote:
> At 12:09 23/07/2009, you wrote:
>
>> HI,
>>
>> Sounds more like single-handed GP bashing.
>>
>> In my experience, there are two types of single-handed GP - Those who
>> work in rural areas where it is the only way a local service can be
>> delivered and those who no other GP wants' to work with. There are a
>> few mavericks, who while impossible as a colleagues, are still
>> wonderful doctors but in general single handed practices in urban
>> areas strike me as something that should have gone a long time ago.
>>
>> Ewan
>
> Why? (Note this is not to say you're wrong - just.... why?)
>
> Julian
Mainly because I guess that a small number of people working together can do
more than the same number working individually. Peer support and supervision
is also important and whole this can be organised for single handers (and
done poorly in a larger practice) it should be better and easier in a group
practice. Thee are economies of scale in terms of buildings, staffing,
equipment etc which will beat the diseconomies of scale with modest numbers
(maybe less of an issue where a single hander shares premises with other
practices). I would also prefer a practice that has the capacity to manage
the absence of a partner with others who know the practice and patients
rather than immediately having to turn to a Locum.
As a patient with increasing, but thankfully still limited, need to use my
GP. What I want first is competent, courteous care (as a patient I have
never experienced anything else in my contact with GPs), next I want
continuity of care delivered not by IT but by dealing with the same small,
stable group of HCPs and mainly one GP who I can build in relationship with
(again I have always been able to find this) As for scale big is not
beautiful and I would suggest that the optimum size of a GP practice,
ignoring any particular local factors, was probably in the order of 10k
patients.
I believe (having had the opportunity to look in many other places) that UK
GP leads in providing first class care and plays a critical role in
"managing" the whole system,. There is always room for improvement, but I
don't see a need for radical change in the way GP services are organised.
Ewan
Ewan Davis - Director - Woodcote Consulting
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