Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

Abstract

Background: Primary care transformation in Scotland aims to improve population health, reduce health inequalities and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP contract though started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working. Aim: To explore progress in the implementation of the GP contract in Scotland in terms of MDT and cluster working. Design and Setting: Qualitative study with key national primary care stakeholders (PCSs) (n=6) and Cluster Quality Leads (CQLs) in clusters serving urban high deprivation areas (n=4), urban mixed areas (n=4), and remote and rural areas (n=4). Methods: Semi-structured interviews with thematic analysis. Results: There was general support for the initial aims of the new GP contract but all interviewees felt that progress on both MDT expansion and cluster working was slow, even prior to the pandemic. None of the CQLs (and few PCSs) felt that GP workload had reduced significantly, nor that the care of patients with complex needs had improved. Lack of time and poorly developed relationships were key barriers, as was a lack of relevant primary care data, and additional support (including guidance, administration, training, and protected time). Conclusion: Key PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.

A mixed-methods evaluation of patients’ views on primary care multi-disciplinary teams in Scotland

“…The results of this study – in particular low awareness of most MDT roles – should be considered in the context of the implementation of the 2018 contract. Local variations in the implementation of the GP contract have been reported, including the provision of MDT services through ‘hubs’ rather than individual GP practices 16, 29 . Moreover, our recent qualitative evaluations of the views of GPs, MDT staff, cluster quality leads and senior stakeholders highlighted the range of challenges affecting the expansion and integration of primary care MDTs in Scotland 16, 17 .…”

“…The implementation of the new GP contract in Scotland has clearly been affected by the pandemic, and other challenges to MDT expansion have been identified 16, 17 , but further work is needed to assess variations in the availability of primary care MDT services across Scotland, as this has implications for interpreting differences in patient views on these reforms. Our findings, however, suggest that despite low awareness of MDT-care, it has broad acceptance and leads to positive patient experiences.…”

“…One of the key objectives of MDT expansion in Scotland was to enable GPs to focus more time on patients with complex needs. Our recent qualitative studies suggest this is not happening 16,17 , even though evidence suggest it would be both cost-effective and beneficial 34,35 . The preference of patients for first contact GP care suggested in this study, and supported elsewhere 30 , represents one barrier to this.…”

“…The expansion of primary care MDTs -including community link workers who focus on connecting patients to non-medical community resources in deprived areas-was central to this. Whether the new GP contract has effectively contributed to the mitigation of health inequalities is not known, but our recent survey of patient experiences and qualitative evaluations of the views of senior primary care stakeholders, GPs, MDT staff, and patients living in deprived areas suggest it has not [16][17][18] .…”

“…Most evaluations of MDT-based models of primary care have focussed on health outcomes and costs 11, 12 . Our aforementioned qualitative evaluations explored the views of a range of professionals with regard to the new GP contract in Scotland 16, 17 . However, the views and experiences of patients remains underexplored 8, 13, 19, 20 .…”