Reports > The Fifth Report > CHAPTER THIRTEEN - Single-Handed Practitioners >
Conclusions
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13.68 |
It seems to me that single-handed practices vary in much the same way as do group practices. Some of each are good, bad or indifferent. Certainly, group practices do not have a monopoly on high quality patient care. Small and single-handed practices have their devotees, particularly among those who seek a personal relationship with their GP and who value the continuity of care which this provides. The number of small practices may be diminishing for a variety of reasons. However, there are still a significant number of them and this is likely to be the position for the foreseeable future. |
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13.69 |
That being so, it seems to me that the policy of the DoH and of PCTs should be to focus on the resolution of the problems inherent in single-handed or small practices rather than to try to reduce the numbers of them in existence. I know that the DoH says that it has no such policy but I have the clear impression that such a policy exists in the regions, if not in Whitehall. It is typified by the attitude that single-handed practices are a problem and that the NHS would be better off without them. As I have said, the numbers are likely to decline with time in any event. |
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13.70 |
I have already described a number of the problems that are inherent in single-handed and small practices. I have also described a number of initiatives that are already being undertaken in an attempt to resolve or mitigate those problems. To my mind, the important thing now is that, for the sake of the patients registered with them, single-handed practitioners should be given more support and encouragement. In return, more should be asked of them in terms of group activity and mutual supervision. It is not for me to suggest how this should best be achieved. The current initiatives are patchy and uncoordinated. I do not suggest that there is a ‘one-size-fits-all’ solution to these problems. The needs of small practices in Cornwall may be very different from those in Central Manchester. What is needed, in my view, is a pooling of ideas, a willingness to examine the ways in which things are done in other places, such as the Netherlands, and a determination to solve the problems. |
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13.71 |
I turn to consider what significance, if any, attaches to the fact that Shipman was always technically a single-handed practitioner and never worked in a group practice with a shared patient list. Did this make it easier for him to escape detection? Did he feel more confident that his crimes would go undetected? First, I observe that Shipman killed at least 71 patients when he was at the Donneybrook practice and that his colleagues at the practice were, through no fault of theirs, unaware of what was going on. This confirms my belief that a devious and aberrant doctor is not significantly more likely to be deterred or detected just because s/he is in partnership and/or working under the same roof with other doctors. I suspect that it was Shipman’s general character rather a feeling of likely detection if he were to remain that caused him to move from the Donneybrook practice. Second, I believe that if the Donneybrook practice had been a true group practice with shared lists, Shipman probably would have felt less confident that he would escape detection. If his fellow doctors had had some involvement in the treatment of those who were to become his victims, he would have felt less confident in making up false medical histories and they might have become suspicious if unusual patterns had developed. Much depends on what would have been the actual arrangements and the extent to which there would have been true mutual supervision or monitoring. Of course, that leaves open the question whether, if that had been the situation, Shipman would ever have applied for the position or remained there for so long - he might well not have done. |
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13.72 |
In my view, the fact that Shipman had his own patient list, and was free from the informal supervision and monitoring that accompanies the sharing of patient lists, did mean that he was less likely to be deterred or detected. However, the availability of other more formal methods of monitoring, through clinical governance, could have had a similar effect. If resources and ingenuity were to be applied to the problem, clinical governance methods of monitoring could be applied to single-handed and small practices, as well as to larger group practices. I do not think that the fact that Shipman was a single-handed practitioner should be used as a reason for preventing GPs from practising alone. |
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Mitigating the Problems of Single-Handed Practice
