Abstract Introduction
Since the General Practice Forward View 2016, practices in England have been encouraged to 'work at scale'. A range of models of collaboration have been adopted. Concerns have been raised that losing the small ‘corner shop' model of general practice would threaten continuity of care, a feature of good general practice, which is associated with better outcomes. We examined the effects of working at scale on continuity of care.
Methods
We compared 210 practices working in close collaborative groups serving populations of >30,000 with 2,827 practices not working in such groups and serving populations of <30,000. We calculated the difference between these in the mean proportion of patients reporting being able to see a preferred GP, a measure of continuity of care, from the General Practice Patient Survey 2017. We controlled for age distribution, proportion with longterm conditions, urban/rural setting and Index of Multiple Deprivation of practice postcode, in a regression model.
Results
The mean proportion of patients reporting being able to see a preferred GP was 45% in practices working in close collaborative groups and 57% in practices not working in such groups (difference after controlling for other factors 9%, 95% confidence interval 7% to 12%).
Conclusions
Practices working at scale tend to deliver less continuity of care. It is important to understand the reasons for this; concerns that working at scale could threaten continuity of care may be justified. External funding details NIHR Policy Research Programme - Policy Research Unit in Commissioning and the Healthcare System.