Has the new Scottish GP contract improved GPs' working lives in deprived areas? A secondary analysis of two cross-sectional national surveys of GPs' views in 2018 and 2023.

Background: The new 2018 Scottish GP contract aimed to reduce GP workload and address health inequalities in primary care.

Aim: To compare the working life experiences of GPs working in affluent and deprived areas in 2023, and assess changes since 2018.

Design & setting: Two postal surveys were conducted in 2018 (n=2465, 56% response rate) and 2023 (n=1378, 30% response rate), of all qualified GPs in Scotland.

Method: Secondary analysis of GP working life experiences (job satisfaction, job pressures, negative and positive job attributes) in the most affluent and deprived quintiles. ANCOVA was used to adjust mean values for GP and practice characteristics that differed significantly between affluent and deprived settings.

Results: In 2023, GPs in affluent areas reported lower job pressures (P<0.001) and fewer negative job attributes (P<0.001) than GPs in deprived areas in both unadjusted and adjusted analysis. Compared to 2018, GPs in affluent areas in 2023 reported significant improvements in job satisfaction, job pressures, and negative job attributes in unadjusted and adjusted analysis, and positive job attributes in adjusted analysis. In contrast, GPs in deprived areas reported a significant increase in job pressures, with no other changes in working life experiences.

Conclusions: Since the implementation of the 2018 Scottish GP contract, stark contrasts continue to exist in the working life experiences of GPs in affluent areas compared with deprived areas. Targeted strategies are required to address the inverse care law in order to achieve the contract's intended goals.