A survey of patients’ experiences of GP consultations since the introduction of the new GP contract in Scotland

Problem

Scotland embarked on a new general practitioner (GP) contract in 2018 with the aim of improving quality of care through a redesign of primary care services. Changes included an expansion of the multidisciplinary team (MDT) with the aim of enabling GPs to provide longer consultations for patients with complex needs and multimorbidity. A stated aim of the contract was to mitigate health inequalities. The aim of this questionnaire study was to determine the characteristics, views and experiences of patients presenting in general practice in three population settings: remote, deprived urban and affluent urban Health Board areas of Scotland.

Approach

A postal questionnaire was sent to a random sample of patients from selected practices who had consulted a GP within the previous four weeks. The practices included those serving mainly affluent urban areas, mainly deprived urban areas, and mainly remote areas. Data was collected on the sociodemographic and health characteristics of patients and the nature and quality of their consultations using validated tools including the CARE Measure and the Patient Enablement Instrument (PEI).

Findings

1053 out of 6291 patients from 12 practices responded (response rate 17%). Response rates were higher in affluent urban areas (27%) than in remote areas (20%) and deprived urban areas (12%) (p<0.01). In the deprived areas, multimorbidity (two or more long term conditions) was more common in consulting patients (78% vs 58% affluent vs 68% remote, p<0.01) and complex presentations (spanning physical and psychosocial issues) were more likely (16% vs 10% affluent vs 11% remote, p<0.01). A higher proportion of consultations in the deprived areas were conducted by telephone (42% vs 31% affluent vs 31% remote, p<0.01). Patients consulting in deprived urban areas viewed the GP as less empathic, reported lower enablement and lower satisfaction from their consultations, and had poorer self-reported outcomes than in both other areas (all p<0.05). On the same measures, patients in affluent urban areas had the best experience of GP consultations (all p<0.05).Overall, face-to-face consultations were associated with higher ratings of empathy, enablement and satisfaction than telephone consultations (all p<0.05) although self-reported consultation outcomes were similar. In all three settings, patients were mostly unaware of the expansion of the MDT (<50% awareness for 3 of 5 MDT roles), although most were happy to be triaged by reception staff (79% affluent urban vs 71% remote vs 66% deprived urban, p<0.01).

Consequences

Despite the vision of the new GP contract, patients in deprived urban areas in Scotland report poorer care and outcomes than those in more affluent urban areas or remote settings. Further efforts are required to tackle the inverse care law in Scotland.