Recent developments put their future in doubt

Do singlehanded general practices have a future in the United Kingdom's NHS? Singlehanded practices—those that have only one principal doctor with a contract with their primary care trust—have been dwindling in number for many years, and this decline has now become much more rapid. Between 1994 and 2003, the number of singlehanded general practitioners fell from 2959 to 2578 (from 10.8% to 8.5% of all general practitioners) in England.1 Between 2003 and 2004, the number fell by a further 660 to 1918 (now comprising 6.1%), a larger fall over one year than in the preceding nine years. Yet singlehanded doctors make up a much larger proportion of the primary care workforce in many other developed countries. For example, in the United States in 1998, 46% of family practitioners and 34% of general internists were practising alone.2

Ever since the foundation of the NHS, singlehanded general practitioners have made an important contribution in the UK, particularly in inner city and rural areas where recruiting general practitioners has proved difficult. These areas often have deprived populations and, in inner city …