The following is a summary of “Practice list size, workforce composition and performance in English general practice: a latent profile analysis,” published in the June 2024 issue of Primary Care by Kayira et al.
In response to government initiatives promoting scalability in English general practices, there has been a notable shift from traditional small, GP-led practices to larger, multidisciplinary entities. This study evaluated how practice list size and workforce composition influence clinical outcomes and patient experience.
Researchers integrated five datasets encompassing practice-level variables across England, including workforce demographics, list size, patient demographics, socioeconomic status, rurality, GP contract types, patient-reported care experiences, and clinical performance metrics from the Quality and Outcomes Framework (QOF) and non-QOF indicators. Latent Profile Analysis (LPA) was employed to categorize practices based on their list size and workforce composition. Statistical criteria such as Bayesian Information Criterion and Akaike Information Criterion guided the determination of optimal groupings supported by team consensus. One-way ANOVA assessed group differences in indicator variables, with linear regression used to examine associations between practice groupings and performance outcomes.
Among 6,024 practices analyzed, three distinct profiles emerged: ‘Small GP-reliant practices’ 4,494 (74.6%), ‘Medium-size GP-led practices with multidisciplinary team (MDT) input’ (23.2%), and ‘Large multidisciplinary practices’ (2.2%). Small GP-reliant practices consistently outperformed larger multidisciplinary counterparts in patient-reported access, continuity of care, and overall satisfaction. However, medium-size GP-led practices with MDT input showed superior confidence and trust indicators results. Differences in QOF metrics were minimal across groups, except for asthma reviews, where medium-size GP-led practices with MDT input lagged behind small GP-reliant practices, and immunization coverage, where they excelled. Larger multidisciplinary practices demonstrated higher cancer detection rates than small GP-reliant practices in non-QOF measures.
Small GP-reliant practices exhibited stronger patient-reported outcomes in access, continuity, and satisfaction, contrasting with larger multidisciplinary practices that showed enhanced cancer detection rates but limited impact on other clinical outcomes. As England’s healthcare landscape shifts towards larger, multidisciplinary models, preserving positive patient experiences should remain a priority.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02462-w
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