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Family Practice Advance Access published online on January 7, 2005
Family Practice, doi:10.1093/fampra/cmh714
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Family Practice © Oxford University Press 2004, all rights reserved.
Received July 12, 2004
Accepted September 27, 2004

Article

Saying ‘goodbye’ to single-handed practices; what do patients and staff lose or gain?

Pieter van den Hombergh 1*, Yvonne Engels 1, Henk van den Hoogen 1, Jan van Doremalen 1, Wil van den Bosch 1, and Richard Grol 1

1 Centre for Quality in Care Research (WOK), University Medical Centre Nijmegen, The Netherlands

* To whom correspondence should be addressed.
Pieter van den Hombergh, E-mail: p.vd.hombergh{at}lhv.nl


  Abstract

Background. The practice setting is, next to the GP and staff, an important determinant of the quality of care. Differences between single-handed practices and group practices in practice management and organization could therefore provide clues for improvement. An explorative, cross sectional survey was conducted in 766 general practices in The Netherlands comparing single-handed practices with group practices.

Objective. The study is looking for answers on aspects of the organization and management that are lost or gained when single-handed GPs and practices are replaced by group practices.

Methods. Between 1999 and 2003 GPs and their practices were assessed using a validated practice visit method (VIP) consisting of 303 indicators describing 56 dimensions of practice management. Instruments used consisted of questionnaires for patients, GPs, practice assistant and a direct observer in the practice. Single-handed practices (1 GP) were compared to group practices or health centres (>2.0 GPs) comparing raw scores on dimensions of practice management. In addition, data were analysed in a regression model with specific aspects of practice management as dependent variables using a general linear model procedure. Independent variables included ‘single-handed/group practice’, ‘rural/urban’ ‘part-time/fulltime’ and ‘male/female’.

Results. Group practices scored better on nearly all aspects of infrastructure except those rated by patients. Patients gave single-handed practices higher marks for service, accessibility and even for the facilities. In single-handed practices GPs reported that they worked more and experienced higher levels of job stress. They delegated less of the medical technical tasks but there is no difference in delegation of preventive tasks/treatment of chronic diseases. Group practices had more computerized medical information and more quality assurance activities, but gave less patient information. Single-handed practices spent more hours on continuous medical education.

Discussion and conclusion. The quality of the practice infrastructure and the team scored better in group practices, but patients appreciated the single-handed practice better. The advantages of single-handed practices could be a challenge for group practices to give better personal, continuous care and to put the patient perspective before organizational considerations. This is underlined by the better score on patient information of single-handed practices. Single-handed practices can reduce their vulnerability and openness to high demand by opening up to the requirements of organised primary care.

Keywords: General practice management and organization; patient opinion; practice visit; quality assurance; single-handed practice.
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