In terms of continuity and size considerations, we've got 2 full time
and 3 part time GPs to a 6500 list and 2 practice nurses. Practically
no staff turnover. However I'm already worried about
continuity/personal care. I've heard some larger practices address it
with Red team, Blue team etc. However I've long suspected that there
would be some benefit to teaming up with other practices to buy in
more expert HR and project management resources.
I would be in the funny farm in short order without my colleagues.
I did work for 9 months as a locum between partnerships when I moved
about 5 years ago, and the singlehander practices were considerably
more "quirky" / worrying (n=5) than the group practices (n=20) I
worked in. I think that was largely because when it's only you, you
know how you do things so getting round to writing up "systems" seems
a complete waste of time. At an extreme one practice I locumed at used
his computer to Rx but wrote no notes at all, not on the computer and
not on paper.
Whilst I think Darzi saying on Radio 4 a few months ago that single
handers have had their day is unacceptable, most are probably
excellent. However, there's probably a case to be made for slightly
more attention to quality assurance/ buddying/ visits so at least
there's some chance of spotting a struggling Dr (and no current
appraisal doesn't really reach that spot yet).
2009/7/23 Ewan Davis <[log in to unmask]>:
> 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
>
> See our website at www.woodcote-consulting.com
>
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