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Br J Gen Pract. 2009 June 1; 59(563): 452.
PMCID: PMC2688058


Francesco Carelli, Professor Family Medicine

In Italy, the government is trying to convince GPs to sign a new contract with many new duties but with not much financial reward. They are also being asked to consider the birth of new mega-aggregations of professionals and practices covering a large extension of the population.

At the same time, the government is considering shifting many services from secondary to primary care.

The reaction from GPs' associations is cautious or negative, seeing this as a disruption of trusts' power in microgroups, as a problem for patients obliged to walk or travel long distances to large buildings where they will have long waiting lists, see many doctors, and end up with a duplication of examinations.

The government's indication is similar to the proposal of ‘GP-led health centres’ in the UK.

So, it is very interesting to read the paper by Morgan and Beerstecker indicating that there is no evidence to suggest that very large practices could provide or are providing more volume or diversity than the current average UK practice.1

Therefore, a policy to create larger practices may not automatically lead to a transfer of work from secondary to primary care. This is because there is not an upper threshold above which practice size creates spare capacity and expertise to deliver a significantly greater volume of more diversity of extra services.

These data are very important and to be considered when we see, at the moment, plural inputs by national governments, for new ‘governances’ for family medicine,2 coming bottom-down, not agreed by primary care,3 by secondary care, or by patients themselves (data for disagreement by Italian national statistic questionnaire where the GP–patient relationship is still seen as the ‘must’), but dangerously pushed by the politicians because of their supposed economic interests, or others not considering what family medicine was, is, and will be (see a European Definition).


1. Morgan CL, Beerstecker HJ. Practice size and service provision in primary care: an observational study. Br J Gen Pract. 2009;59(560):186–190. [PMC free article] [PubMed]
2. Department of Health. Implementing care closer to home: convenient quality care for patients. Part 1: Introduction and overview. (accessed 11 May 2009)
3. Union Medici Italiani. Reaction to pre-aggreement on a new contract with mega-aggregations. (accessed 11 May 2009)

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners