Transforming Primary Care in Scotland and China to meet the needs of an ageing population - are health inequalities being tackled?

Lead Research Organisation: University of Edinburgh
Department Name: Centre of Population Health Sciences


Countries around the world are facing major changes, with many people living to an older age. General Practice and primary care provides much of the healthcare care needs of such ageing populations. China and the United Kingdom (UK) share many similar challenges in health and social care including ageing and wide health inequalities between rich and poor.

In Scotland, significant recent changes have been made in primary care including a new Scotland-only GP contract which includes GP Practices working together in 'clusters' (of 5-8 Practices) to improve the quality of care delivered to their local population, and significant expansion of other members of the primary care team (such as advanced practitioners in nursing, pharmacy, and physiotherapy).

In China, Community Health Centres (CHCs) have been established over recent years. These are similar to GP Practices in Scotland, though somewhat larger, led by GPs working within primary care teams. A key focus - which is much less prominent in Scottish primary care - is systematic preventive care to support people to live healthier lives and manage their own conditions better. There is an important opportunity for each country to learn from each other, as these changes in primary care develop further.

The aim of the study is to explore and compare the effects of these recent changes in primary care in Scotland and China, and to find out if these changes are meeting the needs of ageing patients with long-term conditions, as well as reducing health inequalities. To answer this we will carry out the research in two phases. The first phase will explore what the expected impacts are of the changes in both countries. The second phase will examine the actual impacts and key learning.

To answer these questions, we will use freely available national information on patients views (available in both countries), together with GPs views on job satisfaction, workload, and the recent organisational changes, which we will collect in both countries. We will also speak in-depth to staff and patients in both countries. We will do this in a range of different geographical settings to get more detailed information on their views, and analyse these in terms of common themes, and what has been found to help or hinder progress. We will supplement these findings with routine data recorded in the computerised medical records in both countries. We will then consider the implications of the findings for both countries, and share the findings with the public, government, healthcare staff, and other researchers. The findings may also be of interest to other countries that are embarking on similar attempts to improve primary care to meet the needs of ageing populations, and help tackle health inequalities. A unique feature of the research will be collaboration between researchers with different areas of expertise, in social and medical research.

Planned Impact

The findings will be of interest and value to academic researchers; managers and clinicians; patients, the public and third sector organisations; and others such as policymakers and healthcare policy analysts.

The first group of people who will benefit from this research will be academic researchers in a range of disciplines. Our mixed-methods approach is supported by a highly multidisciplinary team of researchers, with expertise in biomedical medical research, sociology, politics, and management science, and draw on a wide range of methods and skills. Our approach will inform others wishing to undertake multidisciplinary research, and inter-country collaborative research. Depending on the results, the findings of this study have the potential to change our understanding of the 'how' and 'why' of primary care transformation, overall and with respect to ageing and inequalities. We expect the findings to also identify new avenues for future research, including directly supporting future analyses.

The second group of people who will those responsible for the planning, funding, and delivery of care. Better understanding of how to improve quality and reduce health inequalities for elderly patients through radical changes in primary care will be of major importance to front-line primary care clinicians, managers, and those responsible for healthcare policy. Initial impact of the research will inform assumptions about the progress of primary care reforms, identify key barriers and facilitators, and explain underpinning theoretical considerations. Particular consideration of the primary care needs of ageing populations and inequalities in health and healthcare may lead to innovations and improvements in service design. Longer term impact will likely need further research that develops and evaluates complex interventions in the ageing deprived population, at system as well as individual level. Developing such interventions requires the kind of high quality information that this project will provide.

The third group who will benefit are patients, the public and third sector organisations. In the short term, the findings will be of value to these groups by providing up-to-date information on the progress of new models of primary care, and how these are helping or hindering elderly people, and reducing or widening inequalities. In the longer term, the findings will support the development, evaluation and implementation of innovations and interventions to reduce inequalities and improve care and health for all.

The final group who will benefit is anyone who wishes to examine the data we generate and which we are able to share, as outlined in our data management plan. This will then be another important pathway to impact, allowing other researchers to conduct secondary analysis on the data collected. This group includes academic researchers but also analysts working in policy and the health service in the UK or China.


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Donaghy E (2024) Primary care transformation in Scotland: qualitative evaluation of the views of patients. in The British journal of general practice : the journal of the Royal College of General Practitioners

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Donaghy E (2023) Primary care transformation in Scotland: qualitative evaluation of the views of national senior stakeholders and cluster quality leads. in The British journal of general practice : the journal of the Royal College of General Practitioners

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Hu XJ (2022) Healthcare needs, experiences and treatment burden in primary care patients with multimorbidity: An evaluation of process of care from patients' perspectives. in Health expectations : an international journal of public participation in health care and health policy

Description We have explored views on primary care transformation in Scotland through qualitative interviews with key senior stakeholders, GP's, other health care professionals in primary care (the multidisciplinary team) and patients in three different health boards - one serving deprived areas, one serving affluent/mixed areas, and one serving remote and rural areas. We found that reform of primary care following the new GP contract in Scotland (which began in 2016 but was formalized in April 2018) is regarded by almost all participants as having been slow, even prior to the pandemic. However, the pandemic, had a substantial negative impact on progress. Virtually no participants felt that the reforms were reducing health inequalities or meeting the needs of people in later life. We have now supplemented these findings with quantitative data from patient and GP surveys, and routine data from GP computer systems. Analysis of the national patient surveys conducted by the Scottish Government shows a steady decline in patients satisfaction since around 2015 and the introduction of the new GP contract has not halted this decline. We are still awaiting the data on the GP survey and the routine electronic data.
In China, the research has been severely affected by the ongoing pandemic there and the recent wave of severe pneumonia that has swept the country. However, the GP survey has been completed and is being analysed, and interviews have been conducted with 22 GPs which are also being analysed.
Exploitation Route The findings in Scotland are being disseminated widely and discussions are ongoing with the Scottish Government, the BMA, and the RCGP Scotland, as to how the findings might inform future developments in primary care.
Sectors Healthcare

Description Our findings have been used by the Scottish Government and the BMA to inform the next phase of the GP contract in Scotland. I have also discussed our findings with the previous Cabinet Secretary for Health in the Scottish Government. Our findings are also being used by Audit Scotland who are conducting their own investigation into the new GP contract.
First Year Of Impact 2019
Sector Healthcare