Practice list size, workforce composition and performance in English general practice: a latent profile analysis.

Area of Science:

• Health Services Research
• General Practice Management
• Healthcare Quality Improvement

Background:

• General Practices in England are increasingly consolidating into larger, multidisciplinary organizations.
• This study investigates the impact of practice size and workforce composition on performance.
• Previous research has not fully elucidated the trade-offs between practice scale and quality of care.

Purpose of the Study:

• To assess the effect of general practice list size and workforce composition on clinical outcomes and patient experience.
• To identify how different practice models perform across various quality indicators.
• To inform policy and practice regarding the optimal structure of general practices.

Main Methods:

• Linked five practice-level datasets in England.
• Utilized Latent Profile Analysis (LPA) to categorize 6024 practices into three groups based on size and workforce.
• Employed ANOVA and linear regression to analyze performance differences across practice groups.

Main Results:

• Three practice groups were identified: Small GP-reliant, Medium-size GP-led with MDT, and Large multidisciplinary.
• Small GP-reliant practices outperformed larger ones in patient-reported access, continuity, experience, and satisfaction.
• Large multidisciplinary practices demonstrated higher cancer detection rates; no significant differences in most other clinical outcomes were observed.

Conclusions:

• Small, GP-reliant practices excel in patient-reported outcomes and experience.
• Larger multidisciplinary practices show potential benefits in specific areas like cancer detection.
• Future efforts should focus on maintaining high patient experience standards during the transition to larger practice models.