2026/05/17 by Heather McAdam, Benjamin Hunter, David Blane +3 · 2 voices
Health Professions · #Healthcare Quality and Management #Medical Malpractice and Liability Issues #Primary Care and Health Outcomes
paper · doi:10.1016/j.puhe.2026.106341
openalex publication_date 2026/05/17 · openalex created_date 2026/05/18 · openalex updated_date 2026/07/23
OBJECTIVES: GP practices in Scotland are changing with the emergence of megapractices. We aimed to update analyses of GP practice sizes in Scotland, and to begin the development of a typology of GP practices. STUDY DESIGN: Mixed methods. METHODS: We report descriptive analysis of routine data and analysis of publicly available records to support commercial profiling. From this we derived key features and ideal types. RESULTS: Most Scottish practices have less than 9000 patients, but five megapractices with over 30,000 patients were identified. One had grown by over 18,000 patients in two years to almost 120,000 patients, with the next largest at almost 73,000 patients. Megapractices did not engage with interviews, but commercial profiling revealed an array of complex legal and financial arrangements for several of them. The evidence we gathered suggests that the key parameters for describing practices are: ownership, legal status and motives; the extent of service provision by doctors or Allied Health Professionals (AHPs); and practice list size. We tentatively propose four common practice types in Scotland: traditional practices, megapractices, social enterprise practices, and direct NHS provision, recognising substantial diversity amongst megapractices. CONCLUSIONS: Policymakers should carefully consider the implications, negative or positive, of the current drift in approach to GP provisioning. Evaluation of the impacts of new service models on healthcare access, health outcomes and inequalities is urgently needed.