How are large, corporate GP clinics impacting patient care?

A shift in general practice structure towards larger practices may impact future patient care in Australia, according to the authors of a Perspective piece published in the Medical Journal of Australia. The authors from La Trobe University’s Department of Public Health, Dr Caroline de Moel-Mandel and Professor Vijaya Sundararajan, point to considerable changes in the organisational structure of general practice in Australia since the late 1990s.

“At present, 2% of Australian GPs work in solo private practices, while 20% of full-time GPs and 33% of part-time GPs are employed in large practices with six or more GPs,” the authors wrote.

Practice ownership has also undergone change, with 25% of Australian GPs being practice owners in 2020 compared with 35% in 2008. The authors explained that factors such as management responsibilities, financial burdens and a lack of work–life balance have discouraged practice ownership.

“Concurrently, commercial ownership models emerged, ranging from ownership by other health professionals to corporate groups of publicly listed companies, with shareholders having little or no involvement in patient care or practice management,” the authors wrote.

“In 2000, there were six corporate groups; by 2020, two remained, which operate over 400 medical centres. Survey data from 2020 indicate that approximately 16% of GPs work in corporate-owned practices. Co-located services increased as well. In 2016, 81% of practices had pathology services on location versus 49% in 2010; for imaging, these figures are 30% versus 15% and for physiotherapy 50% versus 29% respectively.”

Dr de Moel-Mandel and Professor Sundararajan explained that the size and model of GP practice ownership impacts the following areas:

• Access to care can be affected when multiple smaller practices conglomerate into larger, more centrally located practices, especially for people residing in regional and remote areas where there are already fewer GPs per person.
• Continuity of care: In larger practices, a person’s ‘usual GP’ is often replaced by the ‘usual practice’, which results in patients consulting GPs they may have never met before.
• Quality of care: The authors pointed to research suggesting that the quality of corporatised GP services may be inferior to that delivered by traditional providers.
• Health expenditure: Observed increases in expenditure could be associated with the practice of overservicing to meet income targets, or with GPs over-referring to commercially related and co-located services.
   

The authors concluded that more research is vital to understand the full effects of the changes in GP size and ownership models on patient care.

“While there is little Australian evidence that worse clinical care is delivered in privately or corporate-owned general practices, there is also no evidence that care is better. Hence, if general practice in Australia is to navigate the future changes in practice size, ownership and increasingly co-located service organisation, more Australian research and potentially regulation are needed to track and control what this means for patient care in terms not only of patient experience but also for health outcomes in general practice.”

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