Patients’ experiences of GP consultations following the introduction of the new GP contract in Scotland: a cross-sectional survey

Abstract

Background: The new Scottish GP contract commenced in April 2018 with a stated aim of mitigating health inequalities. Aim: To determine the health characteristics and experiences of patients consulting GPs in deprived-urban (DU), affluent-urban (AU) and remote/rural (RR) areas of Scotland. Design and Setting: Postal survey of a random sample of adult patients from 12 practices who had consulted a GP within the previous 30 days. Methods: Patient characteristics and consultation experiences in the three areas, using validated measures including the Consultation and Relational Empathy (CARE) Measure and Patient Enablement Instrument (PEI). Results: In DU areas, multimorbidity was more common (78% vs 58% AU vs 68% RR, p<0.01); complex presentations were more likely (16% vs 10% AU vs 11% RR, p<0.01); and more consultations were conducted by telephone (42% vs 31% UA vs 31% RR, p<0.01). Patients in DU areas reported lower satisfaction (82% vs 90% AU vs 86% RR, p<0.01); lower perceived GP empathy (mean CARE score 38.9 vs 42.1 AU vs 40.1 RR, p<0.05); lower enablement (mean PEI score 2.6 vs 3.2 AU vs 2.8 RR, p<0.01) and less symptom improvement (p<0.01) than those in AU or RR areas. Face-to-face consultations were associated with significantly higher satisfaction, enablement and perceived GP empathy than telephone consultations in RR areas (all p<0.05). Conclusion: Five years after the start of the new GP contract in Scotland, patients’ experiences on consultations with GPs suggest that the inverse care law persist in deprived areas.

Primary care transformation in Scotland: a qualitative evaluation of the views of patients

“…Strengths of the study were the involvement of the four members of the PPI group in all stages of the study and the inclusion of patients across three diverse health board areas, enabling the consideration of views from patients living in urban deprived areas, urban affluent/mixed areas, and remote and rural areas of Scotland, using the same sampling frame from the authors’ linked work. 8 , 15 , 16 However, as this study recruited from patients who had taken part in the authors’ patient survey (see Supplementary Information S1), it could be that the patients were more motivated to be interviewed because of strong views, positive or negative, than those who did not take part. However, apart from higher levels of multimorbidity (in line with the study’s purposive sampling strategy), there were no differences in any of the consultation quality measures between those interviewed and the rest of the survey sample (see Supplementary Information S1), which gives some reassurance that the patients interviewed were not ‘outliers’ in terms of their views on consultation quality.…”

“…12 The preference for face-to-face consultations, particularly among those from the most deprived areas with complex and mental/physical health needs, echoes other recent research in the UK, 24 – 26 which is concerning given that patients in deprived areas receive more telephone consultations than face-to-face compared with patients in other settings. 16 , 27 …”

“… 32 Providing such holistic care in general practice is challenging anyway, but especially so when consulting remotely. 33 The added burden of the inverse care law makes such care even more challenging in areas of deprivation, 16 , 23 where patients develop multimorbidity some 10–15 years earlier than those living in affluent areas. 1 …”

“…As part of this broader programme, 12 GP clusters were recruited across three Scottish health boards (out of a total of 14 regional health boards) for qualitative and quantitative evaluation. 15 , 16 The participating regional health boards were selected to provide a variety of population characteristics, including urban areas of high deprivation (health board one), urban affluent/mixed (health board two), and remote and rural populations (health board three). Patients who were interested in potentially taking part in the qualitative study were identified from a postal survey of patients (also part of the programme of research).…”

“…Patients who were interested in potentially taking part in the qualitative study were identified from a postal survey of patients (also part of the programme of research). 16 Sampling was designed to ensure that equal numbers of patients were recruited from the three health boards, and that there was a mix of characteristics according to age, sex, deprivation, and number of long-term conditions. Further details of the overall sampling frame, the patient survey, and the sampling of patients for interview are given in the Supplementary Information S1.…”