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

Abstract

Background: The 2018 Scottish GP contract established GP Clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested sub-optimal progress.

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

Design and setting: Cross-sectional postal survey of all qualified GPs in Scotland in 2023 Methods: Comparison of GPs working lives, career intentions and views on the new contract with a similar survey conducted in 2018.

Results: 1378/4529 (30%) GPs responded to the survey compared to 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 < 0.15). Significantly more GPs were planning to reduce hours (p<0.001) and leave direct patient care (p=0.008) in 2023 than 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 felt that MDT expansion was insufficient to reduce their workload. Significantly more practices were trying to recruit GPs, and GPs reported worsening NHS services, higher workload, and lower practice sustainability in 2023. 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 five years after the new contract was introduced, and are responding by planning to reduce their hours or leave direct patient care.