Primary care transformation in Scotland: a comparison of two cross-sectional national surveys of GPs' views in 2018 and 2023

Abstract

Background: The 2018 Scottish GP contract established GP Clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested suboptimal progress with these initiatives.

Aim: To quantify progress since the introduction of the new contract.

Design & setting: A cross-sectional postal survey of all qualified GPs was undertaken in Scotland in 2023.

Method: GPs working lives, career intentions, and views on the new contract were compared with a similar survey conducted in 2018.

Results: In total, 1385/4529 (31%) GPs responded to the 2023 survey compared with 2465/4371 (56%) in 2018. Job satisfaction and negative job attributes were similar in both surveys. Both positive job attributes (P = 0.011) and job pressures (P = 0.004) increased but the changes were small (effect sizes <0.2). Significantly more GPs were planning to reduce hours (P<0.001) and leave direct patient care (P = 0.008) in 2023 than in 2018. Quality leads' views on Cluster working were unchanged, with 70-80% reporting insufficient support. Cluster knowledge and engagement was unchanged but there were small increases in knowledge of quality improvement. More than half of the GPs reported that access to MDT staff was insufficient to reduce their workload in all staff categories except vaccinations. Significantly more practices were trying to recruit GPs (P<0.01), and GPs reported worsening NHS services, higher workload, and lower practice sustainability in 2023 (P<0.001). Only 5% of GPs in the 2023 survey thought that the new contract had improved the care of patients with complex needs.

Conclusions: GPs report few improvements in working life 5 years after the new contract was introduced, and are responding by planning to reduce their hours or leave direct patient care.

Keywords: Scotland; contracts; general practice.

Figure 1

Effect size differences in working life domains in 2018 and 2023. Values that lie to the right of the red dotted vertical line mean that the scores were higher (better) in 2023 than in 2018, and those lying to the left mean the opposite. If the confidence intervals (black bars) cross the red line, then the difference was not statistically significant. It should be noted that, although statistically significant differences were found, the sizes of the differences were small (effect size <0.2).

Figure 2

Future work intentions of GPs in 2023 and 2018. Non-parametric (Mann–Whitney) U test was used to calculate P-values for the future job intentions. The difference between likely to reduce hours in 2023 and 2018 was significant (P<0.001) as was the intention to leave direct patient care (P = 0.008).