Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads.
Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads.
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DOI：
10.3399/bjgp.2022.0186
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发表时间：
2023-03
期刊：
影响因子：
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通讯作者：
Mercer SW
中科院分区：
文献类型：
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作者：
Donaghy E;Huang H;Henderson D;Wang HH;Guthrie B;Thompson A;Mercer SW
苏格兰的初级保健转型旨在改善人口健康，减少健康不平等，减少全科医生的工作量。两个关键战略（2018年4月在新的苏格兰全科医生合同[苏格兰全科医疗服务合同]中正式确定，尽管在2016年初开始）是多学科团队（MDT）的扩展和全科医生集群工作。探讨在苏格兰执行全球伙伴关系合同的进展情况，包括多学科专家小组和集群工作。定性研究与关键的国家初级保健利益相关者（PCS）（n = 6）和集群质量领导（CQL）在集群服务城市高度贫困地区（n = 4），城市混合地区（n = 4），和偏远和农村地区（n = 4）。半结构化访谈与主题分析。与会者普遍支持新的全科医生合同的最初目标，但所有受访者都认为，即使在大流行之前，多学科治疗扩展和集群工作的进展也很缓慢。没有一个CQL（和少数PCS）认为GP的工作量显著减少，也没有对有复杂需求的患者的护理有所改善。缺乏时间和发展不良的关系是主要障碍，缺乏相关的初级保健数据和额外的支持（包括指导，管理，培训和保护时间）也是主要障碍。苏格兰不同地区的主要PCS和CQL报告称，初级保健转型进展有限，仅部分与大流行有关。如果新的全科医生合同要成功地改变苏格兰的初级保健，就需要更好的劳动力规划和支持。
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. To explore progress in the implementation of the GP contract in Scotland in terms of the MDT and cluster working. 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). Semi-structured interviews with thematic analysis. 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). 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.