The Relationship between Size and Performance of Primary Care Organizations in England

National Primary Care Research and Development Centre, University of Manchester, Manchester, UK.
Journal of Health Services Research & Policy (Impact Factor: 1.73). 02/2003; 8(1):11-7. DOI: 10.1258/13558190360468173
Source: PubMed

ABSTRACT To examine the relationship between the size and performance of primary care organisations, the effect of and the reasons for mergers.
Data on size, proxy measures of performance and merger intentions for 71 organisations were extracted from telephone and mail surveys of primary care groups and trusts (PCG/Ts).
Of the 22 performance measures examined, only two were significantly associated with size, and over half were not associated with any of the potential explanatory variables. Most organisations (70%) were planning mergers. If all planned mergers take place, the mean size of primary care organisations will double to nearly 200000. The main reasons for mergers were to make better use of resources and for PCGs to become PCTs.
There is little evidence that the performance or efficiency of a primary care organisation is associated with its size. Optimal size may differ for different functions. Mergers are seen as a way of increasing management capacity and may reflect the desire of managers to manage large organisations. There is a risk that larger primary care organisations will recreate hierarchies and lose local ownership and participation.

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    • "Rentsch (1990) using network analysis found that people involved in the same interaction groups attached similar meanings to organisational practices, whereas people attached to different groups attached different meanings to these events. In line with this, it can be argued that greater social interaction between the management team in smaller organisations relative to larger organisations results in greater local ownership and participation (Wilkin et al., 2003). This can be explained by size causing structural complexity (horizontal structural differentiation multiplied by vertical structural differentiation) and thereby creating more bureaucratic organisational layers (Donaldson, 2001). "
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    • "Fulop et al (2002) discuss the failure to achieve the objectives, and the significant disruption to service development, of NHS trust mergers. Wilkin et al (2003) fail to find any basis for assuming that, beyond a certain point, bigger is better when it comes to primary care organisations. Peck et al (2001) are lukewarm about the benefits of health and social care integration. "
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