General Practice contracts: The impact of contract changes on General Practices in Scotland

In the UK, most GP Practices are run as private businesses that contract with the Government to provide general medical care to the population of patients who are registered with them. General practice in the UK faces increased patient demand from an aging population with multiple morbidities and decreasing numbers of GPs to provide care. In 2018, the Scottish Government and British Medical Association, the Union that represents GPs, agreed a new general practice contract. The contract aimed to improve access to general practice for patients, reduce health inequalities and improve population health. The contract was informed by a survey carried out by Deloitte and commissioned by the Scottish Government and the Scottish General Practice Committee (SGPC). Across Scotland, independent GP partnerships are concerned that the contract does not adequately address the challenges they face. There are two substantial changes in the new contract: the funding formula and the introduction of a multidisciplinary team (MDT) to general practice.

General practices are financed based on adjusted capitation and the contract determines the amount of funding a practice receives based on the number of patients registered with the practice adjusted to account for location and deprivation of the population, associated expenses and workload. The adjustments were changed in the new contract and are reported to favour practices in urban areas compared to those in remote and rural areas.

Given the shortage of GPs, an MDT in general practice aims to reduce patient demand for GPs time and, thus, allow GPs to focus on those patients who require generalist medical care. Health professionals who are part of the MDT include: pharmacists; physiotherapists; mental health workers, paramedics and advanced nurse practitioners. The MDT members should be based within general practices and employed by the NHS to provide patient care. This is a substantial change to how patients are cared for in the community.

The aim of this PhD is to investigate the impact of the new GP Contract on rural and urban GP Practices in Scotland. This can be explored by evaluating the financial effect of the new contract on general practice businesses. It can also be explored by examining: a. how the contract changes affect staff working in practices in remote, rural and urban areas and b. how patient services are affected by the contract and if and how this differs in rural and urban areas. This mixed methods project will combine quantitative analysis of administrative data, secondary analysis of qualitative data in the public domain (interviews, opinions and other pieces of information circulated) and primary qualitative data collection.

This studentship is based in the Health Economics Research Unit (HERU) at the University of Aberdeen with collaborations in University of Aberdeen Business School and Academic Primary Care. HERU is one of the leading units in health economics and is internationally recognised as a centre of excellence for research on the workforce and organisation of health care. The studentship is suitable for candidates with an honours degree (or equivalent) or postgraduate qualification in economics or a business-related discipline.

APPLICATION PROCEDURE:
This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: https://www.abdn.ac.uk/pgap/login.php. You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.

NOTE CLEARLY THE NAME OF THE SUPERVISOR AND EXACT PROJECT TITLE ON THE APPLICATION FORM.

Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants after applications have closed. Candidates will be informed after the application deadline if they have been shortlisted for interview.