BMJ 2001;323:320-323 ( 11 August )

Primary care

Do single handed practices offer poorer care? Cross sectional survey of processes and outcomes

Julia Hippisley-Cox, senior lecturer in general practice, a Mike Pringle, professor in general practice, a Carol Coupland, senior lecturer in medical statistics, a Vicky Hammersley, research network coordinator, Trent Focus, a Andrew Wilson, senior lecturer in general practice. b

a Division of General Practice, University of Nottingham, Nottingham NG7 2RD, b Department of General Practice and Primary Health Care, University of Leicester, Leicester General Hospital, Leicester LE5 4PW

Correspondence to: J Hippisley-Cox julia.hippisley-cox{at}nottingham.ac.uk

Objectives: To determine whether there are important differences in performance between group practices and singlehanded general practitioners and the extent to which any differences are explained by practice characteristics such as deprivation.
Design: Cross sectional survey.
Setting: 206 singlehanded practices and 606 partnerships in Trent region, United Kingdom.
Method: Comparison of process and outcome measures derived from routinely collected data on hospital admissions and target payments for singlehanded practices and partnerships. Multivariate analysis was used to adjust for the confounding effects of general practice characteristics---deprivation (Townsend score), percentage of Asian residents, percentage of black residents, proportion of men over 75 years, proportion of women over 75 years, rurality, presence of a female general practitioner, and vocational training status.
Results: Differences in achievement of immunisation and cytology targets apparent on univariate analysis were not seen after adjustment for other general practice characteristics. Similarly, significant differences (>15%; P<0.01) for three types of hospital admission seen on univariate analysis were not present after adjustment for other practice characteristics.
Conclusions: This study provides no evidence that singlehanded general practitioners are underperforming clinically. Our results offer insight into the structural difference between the two types of practice and underline the importance of the effect of other practice characteristics on process and outcome measures.


What is already known on this topic
Singlehanded general practitioners tend to work in areas of high deprivation and need

Patients like singlehanded practices because of good communication, personal rapport, availability, and continuity of care

Concerns have been expressed about professional isolation and quality standards for singlehanded practice, on the basis of little evidence

What this study adds
This study provides no evidence that singlehanded general practitioners are underperforming clinically

The results offer insight into the structural differences between the two types of practice and underline the importance of other practice characteristics such as deprivation



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Rapid Responses:

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concern
Charmaine Andrews
bmj.com, 12 Aug 2001 [Full text]
Adjusting for practitioner, practice and population factors
Chris Griffiths
bmj.com, 13 Aug 2001 [Full text]
15% Difference versus 30% list inflation in sigle handed practices
David Lloyd
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Erroneous conclusions based entirely on unexplained choice of covariates
Debbie A Lawlor
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A Patient's View
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In some repescts, yes
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Re: In some repescts, yes
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Re: Re: In some respects, yes
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