Health experts have raised concerns about the growing number of ‘mega practices’ in Scotland amid concerns that more patients will be treated by nurses and cut-price medics rather than GPs.
A nationwide shortage of family doctors has led to health facilities merging, with ‘huge leaps’ in the number of people being treated by some.
Now a study shows some practices have seen their patients lists grow to more than 100,000 people.
Health leaders are concerned the move threatens the treasured doctor-patient relationship, as patients are less likely to see the same medic each time.
Experts fear the mega practices could use cost-cutting measures such as hiring more nurses instead of GPs and have called for more research to understand the impact.
Experts warn that the patient and doctors relationship will be impacted if practices have a large number of people on its list
Scottish Conservative health spokesman said that smaller GP practices play a vital role in their communities
A study led by the University of Glasgow has found one practice has a total list of more than 101,000 patients in nine surgeries across Glasgow, Edinburgh and West Lothian, making it the biggest GP practice in Scotland. The second biggest, with 11 surgeries in Lanarkshire, Forth Valley and Glasgow, had a patient list of 77,000.
Study lead author Gerry McCartney, Professor of Wellbeing Economy at the University of Glasgow, said: ‘Very little is known about the effects of the emergence of mega practices.Concerns about the availability and accessibility of GP services have been raised.
‘The impacts of these changes to service provision, patient experience and population health outcomes are unknown.’
Dr Chris Johnstone, study co-author and a former GP added: ‘There are no specific rules or regulations around how mega practices operate, so things like patient access and staff pay all comes down to their own particular ethos.’
The trend has occurred amid a shortage of GPs, with the number of surgeries in Scotland down from 994 in 2013 to 905 in 2023. The number of GPs dropped by 40 between 2022 and 2023, from 4,514 to 4,474.
Scottish Conservative health spokesman Dr Sandesh Gulhane said: ‘Smaller practices play a crucial role in their communities and I worry that a rise in so-called GP mega practices could threaten patients’ continuity of care and access to GPs.’
The British Medical Association (BMA) has said ‘huge leaps in practice list sizes’ have been seen across ‘most of Scotland’, driven, in part, by the merger of many health centres.
Dr Andrew Buist, chair of the BMA’s Scottish GP committee, said: ‘There are questions over how the centralised approach needed for mega-practice models influences the services available to patients in some cases.
‘In practices with large numbers of clinicians, continuity can sometimes be reduced, which can be particularly important for elderly patients and those in more deprived areas.’
A Scottish Government spokesman said: ‘We are fully committed to increasing the number of GPs in Scotland and have invested over £1.2billion in General Medical Services in 2023-24 to ensure more people get the right care in the right place at the right time.’
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