Primary care transformation in Scotland: qualitative evaluation of the views of general practitioners and multidisciplinary team staff members

Abstract

Background: The Scottish Government’s vision to transform primary care includes expansion of the primary care multidisciplinary team (MDT), formalised in the new GP contract in April 2018. Aim: To explore views on expansion of MDT working in Scotland. Design and Setting: Qualitative study with GPs (n=8) and a range of MDT staff (n=19) working in three different population settings in Scotland conducted between May and June 2022. Methods: In-depth semi-structured interviews with thematic analysis. Results: Internal challenges facing MDT staff included adapting to the fast pace of primary care, building new relationships, training and professional development needs, line management issues, and monitoring and evaluation of performance. External challenges included the ongoing effects of the pandemic, lack of time, difficulties with hybrid working, and low staff morale. Most GPs reported that expansion of their roles as expert medical specialists had not yet happened, as their workload had not decreased (and in many cases had increased). In deprived areas, insufficient resources to deal with the high numbers of patients with complex multimorbidity remained a key issue. Interviewees in remote and rural settings felt the new contract did not take into account the unique challenges of providing primary care services in such areas, and recruitment and accommodation were cited as particular problems. Conclusion: Although there has been substantial expansion of the primary care MDT, many challenges to effective implementation remain which must be addressed if transformation of primary care in Scotland is to become a reality.