Innovation in general practice: is the gap between training and non-training practices getting wider?

BACKGROUND Training practices are more developed than non-training practices in terms of a wide range of educational and clinical activities, facilities and staff. If training practices are also adopting new innovations at a faster rate than non-training practices the gap between them will increase. AIM The aim of this study was to determine whether, between 1982 and 1990, training practices did develop at a faster rate than non-training practices. METHOD In 1982 a questionnaire was sent to 153 practices in Gloucestershire, Avon and Somerset which all had one or more partners who were members of the Royal College of General Practitioners. A second questionnaire was sent to the same practices in 1990. Information was sought about practice features including organization, size, facilities, staff and clinical and educational activities. A total of 124 practices (62 training and non-training) completed questionnaires on both occasions. RESULTS There were substantial changes in the cohort between the surveys in 1982 and 1990, with many practices gaining, for example, a practice manager, practice nurse and purpose built premises, and introducing audits, screening activities and specific clinics. For each feature of practice a logistic regression was undertaken with training used as an explanatory variable. Training practices were more likely to develop than non-training practices for a number of features including personnel, aspects of practice organization, educational activities, clinical activities and equipment. CONCLUSION Training practices are not only more developed than non-training practices but are also more innovative. The gap between training and non-training practices did grow wider between 1982 and 1990. This may be because the members of training practices are inherently more innovative, face fewer obstacles to innovation or that the scheme for approval of practices for training has encouraged specific innovations. Any future accreditation scheme for general practices must be organized to encourage accelerated development in less developed practices rather than only stimulate innovation in already advanced practices.