GP expenses data challenge notion that bigger is better for general practice

Larger practices may not necessarily benefit from economies of scale, official data suggest.

GPC member and Wessex LMCs chief executive Dr Nigel Watson
GPC member and Wessex LMCs chief executive Dr Nigel Watson

Figures published by NHS Digital (formerly the Health and Social Care Information Centre) suggest that practice expenses per registered patient actually increase the bigger it gets.

The data show that expenses per registered patient remain flat or fall slightly as the number of GP partners at a practice increases. However, when the total number of GPs working at a practice is considered, the data show that costs per patient increase as the practice's GP workforce grows.

Average practice expenses per patient in 2013/14 were £88.49 for single-handed G/PMS practices, compared with £91.11 for practices with two or three GPs, £95.82 for four or five, and £98.45 for practices with six or more GPs.

General practice at scale

One specialist medical accountant, Ramsay Brown partner Laurence Slavin, said the figures - collated for NHS England’s review of the Carr-Hill GP practice funding formula - ‘seem to dispel the myth that bigger is better’.

GPC member and Wessex LMCs chief executive Dr Nigel Watson said that while there were ‘economies of scale’ in back-office functions as practices expand, ‘the more doctors you have, the more people you have to service so it does tend to drive up [costs]’.

Although the figures showed expenses per registered patient remain roughly flat when measured by count of GP partners, falling from £95.81 per patient for a G/PMS single-hander to £93.69 for six or more GPs, Dr Watson said he could not conclude from the data that hiring extra partners was more cost effective for practices than employing GPs.

GP partners

The role of contractor and salaried GP will vary from practice to practice, he said. But he added: ‘There is no doubt that if you are a partner it is your business; certainly in my practice if we run out of appointments we do an emergency surgery and it's the partners generally seeing the additional patients.’

The data is being fed into NHS England’s current review of the Carr-Hill practice funding formula. The review group, which includes GPC representatives and NHS and DH officials, is looking at whether the formula should be updated to better reflect the additional workload created by deprivation. It is expected to report ahead of negotiations for the 2017/18 GP contract.

Photo: Pete Hill

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