Exploring changes in patient experience associated with growth and collaboration in English general practice: observational study using data from the General Practice Patient Survey

Background For the last few years, English general practices, which are traditionally small, have been encouraged to work together to serve larger populations of registered patients, by merging or collaborating with each other. Meanwhile, patient surveys suggest worsening continuity of care and access to care
Aim To explore whether increasing size of practice population and working collaboratively are linked to changes in continuity of care or access to care
Design and setting Observational study in English general practice using data on patient experience, practice size and collaborative working
Methods The main outcome measures were General Practice Patient Survey practice-level proportions of patients reporting positive experiences of access and relationship continuity of care. We compared change in proportions 2013-2018 among practices that had grown and those that had stayed about the same size. We also compared patients’ experiences by whether practices were working in close collaborations or not in 2018.
Results. Practices that had grown in population size had a greater fall in continuity, by 6.6% (95% confidence interval 4.3% to 8.9%) than practices that had stayed about the same size, after controlling for other factors. There was no similar difference in relation to access to care. Practices collaborating closely with others had marginally worse continuity of care than those not working in collaboration and no important differences in access.
Conclusion Concerns that larger general practice size threatens continuity of care may be justified.