Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads

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Abstract
Background: Primary care transformation in Scotland aims to improve population health, reduce health inequalities, and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP contract [Scottish General Medical Services contract], although started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working.Aim: To explore progress in the implementation of the GP contract in Scotland in terms of the MDT and cluster working.Design and setting: Qualitative study with key national primary care stakeholders (PCSs) (n= 6) and cluster quality leads (CQLs) in clusters serving urban high deprivation areas (n= 4), urban mixed areas (n= 4), and remote and rural areas (n= 4).Method: Semi-structured interviews with thematic analysis.Results: There was general support for the initial aims of the new GP contract but all interviewees felt that progress on both MDT expansion and cluster working was slow, even before the pandemic. None of the CQLs (and few PCSs) felt that GP workload had reduced significantly, nor that the care of patients with complex needs had improved. Lack of time and poorly developed relationships were key barriers, as was a lack of relevant primary care data, and additional support (including guidance, administration, training, and protected time).Conclusion: Key PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.

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