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

Abstract

Objectives The new general practitioner (GP) contract for Scotland, introduced in 2018, established GP Clusters and expanded multidisciplinary team (MDT) working. This paper compares the views of GPs in Scotland regarding the new contract, their working lives, and career intentions in 2018 and 2023. Methods Cross-sectional postal survey of all qualified GPs in Scotland in late 2023 exploring views on Cluster working, MDT-expansion, their working lives, and career intentions, compared with a similar survey from 2018. Results Job pressure was significantly higher in 2023 than 2018, but overall job satisfaction and negative job attributes were unchanged, while positive job attributes improved. More GPs were planning to reduce their hours and leave direct patient care in 2023 than 2018. Quality leads views on Cluster working were unchanged, with 70-80% reporting insufficient support in both surveys. Cluster knowledge and engagement was unchanged but all GPs showed small but significant increases in understanding of quality improvement. Most felt MDT expansion was insufficient to reduce workload and fewer GPs reported giving longer consultations for complex patients in 2023 than 2018. Significantly more practices were trying to recruit GPs in 2023, and GPs reported worsening NHS services, higher workload, and lower practice sustainability. Only 1 in 20 GPs in the 2023 survey thought that the new contract had improved the care of patients with multimorbidity. 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.