title: Saying 'goodbye' to single-handed practices; what do patients and staff lose or gain?
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/full-time' 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Quality in Care Research (WOK), University Medical Centre Nijmegen, The Netherlands. p.vd.hombergh@lhv.nl
authors.forename: Pieter
authors.initials: P
authors.lastname: van den Hombergh
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Engels
authors.forename: Henk
authors.initials: H
authors.lastname: van den Hoogen
authors.forename: Jan
authors.initials: J
authors.lastname: van Doremalen
authors.forename: Wil
authors.initials: W
authors.lastname: van den Bosch
authors.forename: Richard
authors.initials: R
authors.lastname: Grol
mesh_terms: D005194:Family Practice / Q000458:organization & administration* / Q000639:trends; D005260:Female; D006123:Group Practice / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011331:Private Practice / Q000458:organization & administration* / Q000639:trends; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires