ࡱ> AC@y bjbjEE *$'':  cccccwww8 $w!(3!5!5!5!5!5!5!$"N%Y!cY!ccn!bbbcc3!b3!bbw h  7#wv| !!0! %p% %c bY!Y!b!%  ):  LMC POSITION PAPER ON SINGLE HANDED PRACTICE (DRAFT 1 May 2001) Current Numbers in Somerset At present 11 doctors in Somerset are in true single handed practice and a two nominal single handed practices are job-shared. This number has remained broadly constant in the last 10 years as three new practices were created by the old FHSA and some others have become two or three handed. Contractual position There has so far been no formal change in the regulatory position of single handed doctors, despite the effects of the Shipman case. 2.1 The LMC considers that there can be no requirement laid upon single handed doctors to change their contract position without primary legislation. It is open to doubt whether even this could force GPs to change their current contracts, as such a law might well contravene both current UK and also European legislation. The government has expressed a wish that single handed GPs adopt a PMS contract. The LMC sees no service benefit that requires such a change. Benefits of Single Handed Practice Patient Preference Patients of single handed practices often express a preference for such practices because they know the doctor. Appointments tend to be easier to obtain, the ambience of the practice is more friendly, and patients feel less pressured. Practitioner Preference Some doctors clearly prefer to work on their own rather than in partnership. There is no evidence that single handed doctors per se provide care that leads to worse outcomes than patients of group practices. Advantages of a Mixed Economy In areas of higher population density patients should be able to choose between different styles and configurations of practice according to their preferences and needs. Service Requirement in Rural Areas In rural areas with a scattered population single handed or small practices may be the only way in which patients can obtain a service reasonably close to where they live. Difficulties in Single Handed Practice These seem to fall into three categories, none of which presents an insoluble problem 4.1 Limited Access to Resources Single handed practices cannot on their own afford high quality practice management or other special skills. The LMC considers that this can be overcome by encouraging PCG/Ts to facilitate the sharing of skilled staff and resources as appropriate. Concerns about Clinical Governance A practitioner on his or her own may start to diverge significantly from current normal practice, which could lead to difficulties. By having an arrangement with an adjacent practice for shared audit and CME activities this can be identified and changed when appropriate. There may also be some advantage in other clinical staff sharing work across more than one practice. There is no evidence that enforcing either shared activity or a new contract type can prevent criminal activity by a practitioner. Fewer Specialist-Generalist Skills In a larger practice individual partners will tend to develop expertise in particular clinical areas that can be used for internal referral by other partners. Clearly a single handed doctor cannot acquire all of the skills accessible in a larger practice. However, there is no reason why he or she should not have access the knowledge of colleagues either by direct referral within the PCT or through educational activities. A single hander will perforce remain a true generalist with the ability to assess (and refer if necessary) whatever clinical problems present. Conclusions The LMC supports the continuation of single handed practice as an important alternative choice for both patients and doctors The LMC resists any attempt to impose a PMS contract upon single hander practices as being both unnecessary and unjust. The LMC supports any reasonable arrangement by PCG/Ts to develop clinical governance structures in smaller practices that are based on sharing of experience and educational time The LMC asks PCG/Ts to further explore initiatives for sharing facilities, staff, and resources between practices to help smaller practices obtain access to the same level of facilities as larger groups enjoy.     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