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Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes

Sean Urwin et al.

Journal of Health Economics2026https://doi.org/10.1016/j.jhealeco.2026.103122article
AJG 3ABDC A*
Weight
0.50

Abstract

Ownership of English general practices by physicians has been declining for many years and concentrated among fewer physicians. Non-clinical ownership may provide a sustainable alternative structure for general practice. In this study, we provide the first formal evaluation of non-clinical ownership in an English general practice setting. We compile a comprehensive dataset of general practices across eight years between 2015/16 and 2022/23 from a range of sources to investigate the impact of non-clinical ownership stakes on key primary care outcomes, including staffing levels and turnover, patient satisfaction, access, quality of care, reimbursement for non-core services and total patient list size. Employing a dynamic event study design combined with propensity-score weighting, we find practice manager partners increase direct patient care (excluding physicians and nurses), administrative staff numbers, reimbursement for non-core services and total patient list size. However, we find no statistically significant effect on any other outcome. Offering equity stakes to non-physician staff may support practice sustainability by allowing alternative ownership structures.

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https://doi.org/https://doi.org/10.1016/j.jhealeco.2026.103122

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@article{sean2026,
  title        = {{Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes}},
  author       = {Sean Urwin et al.},
  journal      = {Journal of Health Economics},
  year         = {2026},
  doi          = {https://doi.org/https://doi.org/10.1016/j.jhealeco.2026.103122},
}

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Shared Stakes in English General Practice: The Impact of Practice Managers as Partners on Outcomes

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Evidence weight

0.50

Balanced mode · F 0.40 / M 0.15 / V 0.05 / R 0.40

F · citation impact0.50 × 0.4 = 0.20
M · momentum0.50 × 0.15 = 0.07
V · venue signal0.50 × 0.05 = 0.03
R · text relevance †0.50 × 0.4 = 0.20

† Text relevance is estimated at 0.50 on the detail page — for your query’s actual relevance score, open this paper from a search result.