Evaluation of Primary Care Transformation in Scotland - Summary of findings from an independent programme of research by the University of Edinburgh: Executive Summary - National Scottish GP Survey 2023

Background: A national survey of GPs in Scotland’s working life and views on the new GP contract was conducted in late 2023/early 2024 and compared with a similar survey in Scotland in 2018. The characteristics of respondents and their practices in 2023 and 2018 were very similar, allowing a direct comparison. In both years, the surveys were broadly representative of all GPs in Scotland.

Key Findings: Compared with survey findings in 2018:

➢ Years in practice, and current employment models were similar but sessions worked per
week, and holiday taken per year by GPs were both significantly lower in 2023.
➢ There was a significant overall improvement in GPs positive work attributes in 2023 but
work pressure was significantly higher and negative work attributes and work satisfaction
were unchanged.
➢ Cluster Quality Leads’ (CQLs) and Practice Quality Leads’ (PQLs) views on cluster working
were largely unchanged, with approximately 80% reporting insufficient support. However,
other GPs (non-CQL/PQLs) showed some significant improvements in their views on
clusters, especially on their understanding of quality improvement.
➢ On average, GPs felt that only 8.5% of their previous clinical work was now delegated to
MDT staff, but felt that around a fifth (22.4%) of their current work could safely be
delegated (if there were sufficient MDT staff).
➢ Although GPs in the 2023 survey were generally positive about the expansion of the MDT
only a third overall reported that had reduced their workload.
➢ Only 1 in 20 GPs in the 2023 survey thought that the new contract had improved the care of
elderly patients with multimorbidity, or improved the care of younger deprived patients
with multimorbidity.
➢ Significantly fewer GPs reported giving longer consultations for complex patients in 2023
than in 2018 (39.8% versus 52.2%, respectively).
➢ Significantly more GPs reported that their practices were trying to recruit GPs (35.8% versus
30.5% in 2018) and had been trying to recruit for longer (42% > 12 months versus 30.9% in
2018).
➢ GPs in the 2023 survey felt that NHS services in their local areas had significantly worsened
in the last 12 months, that practice workload was higher, and the long-term sustainability of
the practices was worse compared with the 2018 survey.
➢ Significantly more GPs in 2023 were planning to reduce their hours and leave direct patient
care in the next 5 years. In those below 55 years of age, significantly more planned to reduce
their hours, leave direct patient care, and leave medical work entirely in 2023 compared
with 2018. The biggest difference was in planning to reduce hours (42% of all GPs in 2023
versus 35% in 2018).

Conclusions

Although there have been some improvements in GPs views on some aspects of working life and the new GP contract in Scotland, most aspects have remained the same and some have worsened since 2018. GPs appear to be responding by reducing or planning to reduce their workload or leave direct patient care, which is a worrying picture given the GP recruitment difficulties reported.