The exchanger is not the big draw-back, it is boiler design overall. Old cast-iron gas boilers with balanced flues would pour heat out of the flue wasting heat, when the burner was off. So, between each frequent boiler cycle great heat loss. A thermal store attached to these old boilers eliminating cycling improves efficiency a hell of a lot, as they have one long burn.
Fan flues improved matters a lot and having extended flues, so heat doesn't easily escape when the burner is off helps again. A large water jacket in a boiler with a fanned flue and long flue lengths reduces boiler cycling.
Small capacity tubed heat exchanger boilers came in to reduce size and get them wall mounted to easily fit in small homes. Oil boilers still had large water jackets while gas boilers virtually eliminated them. These large water jackets were enlarged in oil boilers and used as thermal stores for instant water heating. Some oil combis have quite decent flowrates. The extra water mass reduced inefficient burner cycling too.
IMI introduced the Powermax. A non-condensing boiler with large water jacket (thermal store). The flue/exchanger ran up the centre of the thermal store. The heating and instant DHW ran off this store of water. Heat did escape up the flue, however long flues made it more efficient. The current Potterton Powermax is totally different to the IMI original.
ACV have now introduced a large stainless steel water jacket in the condensing HeatMaster boiler with the burner at the top and the exchanger/flue down the centre and exiting at the bottom. No heat floats out the top and through the open flue when the burner is off as did with the original Powermax. The water jacket (thermal store) supplies the heating directly and a cylinder is immersed inside the water jacket for DHW. Efficiencies and recovery rates are very high and all in one box. There are oil versions I believe by replacing the burner.
So, large water jacketed heat exchangers are not inefficient in themselves. It is the total boiler package that matters. Other one-box solution boilers have thermal stores/heat banks inside, but these are separate boilers with their own small water capacity tubed heat exchangers and a separate cylinder. The water mass in the cylinder is not the boilers water jacket.
The ACV points the way back to large water jacket heat exchanger gas boilers, with the water jacket eliminating the need for a separate water stored water vessel.