Scottish General Practitioners Research Articles

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study

ObjectivesTo explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs).DesignQualitative descriptive study employing one-to-one semistructured virtual interviews analysed...

Public health pedagogy and digital misinformation: Health professional influencers and the politics of expertise

This article asks: ‘To what extent can health professional influencers function as health pedagogues, educating their audiences and protecting public health in an era of digital misinformation?’ The article teases out that question by applying Content Analysis and Framing Analysis to a selection of TikTok and Instagram posts by Dr Michael Mrozinski, a Scottish general practitioner who is based in Australia. The posts seek to debunk online misinformation and provide facts regarding COVID-19. Mrozinski's social media content exemplifies what the article terms ‘public health pedagogy’ (PHP) – pedagogy that is informed by public health principles and that is undertaken outside traditional educational institutions. The article also asks: ‘How exactly does Mrozinski respond to misinformation actors and to what extent does this diminish the effectiveness of his PHP?’ The article investigates whether Mrozinski's hostility towards these actors actually invokes stereotypes of medical experts as elitist and uncaring. Those stereotypes are commonly expounded by misinformation and conspiracy actors.

Improving access to primary care: a mixed-methods approach studying a new review appointment system in a Scottish GP practice

A Scottish general practitioner (GP) practice proposed an improvement intervention, shorter pre-bookable ‘review’ appointments, to increase appointment capacity and meet their patients’ demand for appointments. Staff are now able to...

GPs at the Deep End: Identifying and addressing social disadvantage wherever it lies.

GPs at the Deep End first started in Scotland and brought together Scottish general practitioners (GPs) working in the 100 most deprived practices in the country. The group continues to provide peer support, advocacy, training and research opportunities to learn more about general practice in disadvantaged areas. In 2016, Canberra GPs came together to form a local Deep End group, supported by the Scottish initiators. To describe the process and benefits ofbeginning a local Deep End group inthe Canberra region. The Canberra Deep End group includes GPs working with a diverse group of patients from disadvantaged areas. Since its inception, the group has met regularly to discuss local issues, advocate for change in local government policy, and provide peer support and learning opportunities. We highlight this powerful movement to Australian GPs working in areas of disadvantage and encourage others to develop their own Deep End group.

Never events in general practice: a focus group study exploring the views of English and Scottish general practitioners of ‘never events’

ObjectivesTo examine general practitioner (GP) understanding of the never event (NE) concept in general practice, and to identify potential enablers and barriers to implementation in UK general practice.DesignQualitative study using...

Limited impact of awareness-raising campaigns on hepatitis C testing practices among general practitioners.

The global hepatitis strategy calls for increased effort to diagnose those infected, with a target of 90% diagnosed by 2030. Scotland's Action Plan on Hepatitis C included awareness-raising campaigns, undertaken during 2008-2011, to promote testing by general practitioners. We examined hepatitis C virus (HCV) testing practice among general practitioners before and following these campaigns. Scottish general practitioners were surveyed, using Dillman's method, in 2007 and 2013; response rates were 69% and 60%, respectively. Most respondents offer testing when presented with a risk history (86% in 2007, 88% in 2013) but only one-fifth actively sought out risk factors (19% in 2007, 21% in 2013). Testing was reportedly always/almost always/usually offered to people who inject drugs (84% in 2007, 87% in 2013). Significant improvements in the offer of testing were reported in patients with abnormal LFTs (41% in 2007, 65% in 2013, P<.001) and who had received medical/dental treatment in high prevalence countries (14% in 2007, 24% in 2013, P=.001). In 2013, 25% of respondents had undertaken HCV-related continued professional development. This group was significantly more likely to actively seek out risk factors (P=.009) but only significantly more likely to offer a test to patients who had received medical/dental treatment in high prevalence countries (P=.001). Our findings suggest that government-led awareness raising campaigns have limited impact on general practitioners' testing practices. If the majority of the HCV-infected population are to be diagnosed, practitioner-based or physician-centred interventions should be considered alongside educational initiatives targeted at professionals.

Ian Bruce Sneddon (1915-1987).

Ian Bruce Sneddon (1915-1987).

Greater number of group identifications is associated with healthier behaviour: Evidence from a Scottish community sample.

This paper investigates the interplay between group identification (i.e., the extent to which one has a sense of belonging to a social group, coupled with a sense of commonality with in-group members) and four types of health behaviour, namely physical exercise, smoking, drinking, and diet. Specifically, we propose a positive relationship between one's number of group identifications and healthy behaviour. This study is based on the Scottish portion of the data obtained for Wave 1 of the two-wave cross-national Health in Groups project. Totally 1,824 patients from five Scottish general practitioner (GP) surgeries completed the Wave 1 questionnaire in their homes. Participants completed measures of group identification, group contact, health behaviours, and demographic variables. Results demonstrate that the greater the number of social groups with which one identifies, the healthier one's behaviour on any of the four health dimensions considered. We believe our results are due to the fact that group identification will generally (1) enhance one's sense of meaning in life, thereby leading one to take more care of oneself, (2) increase one's sense of responsibility towards other in-group members, thereby enhancing one's motivation to be healthy in order to fulfil those responsibilities, and (3) increase compliance with healthy group behavioural norms. Taken together, these processes amply overcompensate for the fact that some groups with which people may identify can actually prescribe unhealthy behaviours.

Development and validation of a model to predict the 10-year risk of general practitioner-recorded COPD.

Background:There is increasing interest in the earlier detection of, and intervention in, patients at highest risk of developing chronic obstructive pulmonary disease (COPD).Aims:The objective of this research was to develop and validate a risk prediction model for general practitioner (GP)-recorded diagnosis of COPD.Methods:We used data from 239 Scottish GP practices; two-thirds were randomly allocated to a derivation cohort and the other third to a validation cohort. We included patients aged 35–74 years at the cohort entry date, and excluded patients with a recorded diagnosis of COPD prior to the entry date and with missing data on smoking status.Results:There were 480,903 patients in the derivation cohort and 247,755 in the validation cohort. The incidence of COPD in the total cohort was 5.53/1,000 patient-years of follow-up (95% confidence interval (CI), 5.46–5.60). In the derivation cohort, the COPD risk for ever- versus never-smokers was substantially higher in women (hazard ratio (HR)=9.61, 95% CI, 8.92–10.34) than in men (HR=6.72, 95% CI, 6.19–7.30). Other risk factors for both sexes were level of deprivation and a previously recorded asthma diagnosis. In the validation cohort, the model discriminated well between patients who did and those who did not develop COPD: area under the receiver operating characteristics curve=0.845 (95% CI, 0.840–0.850) for females and 0.832 (95% CI, 0.827–0.837) for males.Conclusions:We have developed and validated the first risk prediction model for COPD, which has the major advantage of being populated entirely by routinely collected data and consequently may be used for clinical practice.

Revision of Scottish GP contract removes one in four QOF points

Changes to the GP contract in Scotland have been agreed for 2014-15, including the removal of one in four points from the Quality and Outcomes Framework (QOF).1 As part of the changes, agreed by the British Medical Association’s Scottish General Practitioners Committee and the Scottish government, 264 points will be removed from QOF, leaving a total of 659 points. To offset funding lost through …

BMA “bitterly disappointed” at 1.25% contract uplift for Scottish GPs

The BMA has said it is “bitterly disappointed” with the 1.25% uplift to the general medical services (GMS) contract awarded to GPs in Scotland. The uplift will allow for a 1% salary increase for GPs, in line with the 1% increase all other health workers have received from 1 April, the Scottish government has said. But the BMA’s Scottish General Practitioners Committee has pointed out that the uplift is the …

GPs in Scotland avoid most of the negative QOF changes highlighted by BMA

GPs in Scotland will not be subject to most of the changes to the Quality and Outcomes Framework (QOF) that the BMA thinks will have a negative effect on general practice.1 Most of the changes to QOF recommended by the National Institute for Health and Clinical Excellence (NICE) for the 2013-14 general medical services (GMS) contract will go ahead in Scotland. However, the Scottish General Practitioners Committee and the Scottish government have negotiated “substantial amelioration” of the recommendations. The committee’s chairman, Alan McDevitt, said, “I believe these arrangements will improve patient care and go some way to mitigating workload pressures. The success of the …

A “Crutch to Assist in Gaining an Honest Living”: Dispensary Shopkeeping by Scottish General Practitioners and the Responses of the British Medical Elite, ca. 1852–1911

This article examines the practice among general practitioners in Scotland of keeping shops for dispensary and retail purposes in the late nineteenth century. It demonstrates that while doctors kept such open shops in these areas in order to subsidize their income in a crowded medical market, they argued that shopkeeping allowed them to provide medical care in communities where the population was otherwise too poor to pay for such care. The article compares shopkeeping to medical "covering" and assesses the medical hierarchy's reactions to shopkeeping doctors via disciplinary actions taken against some of these doctors by the General Medical Council (GMC). These actions provoked an organized protest among hundreds of doctors (some of it channeled through the British Medical Association), which challenged the methods of the GMC in determining acceptable professional medical standards.

A retrospective cohort study assessing patient characteristics and the incidence of cardiovascular disease using linked routine primary and secondary care data

ObjectivesData linkage combines information from several clinical data sets. The authors examined whether coding inconsistencies for cardiovascular disease between components of linked data sets result in differences in apparent population...

Use of the ‘Hall technique’ for management of carious primary molars among Scottish general dental practitioners

To assess the current awareness, usage and opinion of the Hall technique as a restorative option for primary molars in Scottish general dental practice; and to identify preferences for methods of further training, if desired, for those not currently using the technique. A postal questionnaire was sent to a random sample of Scottish general dental practitioners (GDPs) (n= 1207). Half of all GDPs within each health board were mailed. All analyses have been carried out in Minitab (version 15). The study is primarily descriptive and uses frequency distributions and cross-tabulations. Percentages are reported with p5% confidence intervals. Characteristics of the whole sample were reported. However when reporting the use of the Hall technique, only those GDP's reporting to treat children, at least sometimes are considered. Following two mail-shots, the overall response rate was 59% (715/1207). Eighty-six percent (616/715) of respondents were aware of the Hall technique as a method of restoring primary molars and 48 % (n=318) were currently using the Hall technique. Of those GDPs who never used the Hall technique (51% of total respondents; n=340), 46% (n=157) indicated they were either 'very interested' or 'interested' in adopting the Hall technique into their clinical practice. The preferred source for further training was via a section 63 continuing professional development (CPD) course, incorporating a practical element. Of those GDPs in Scotland who responded to the questionnaire, an unexpectedly high number were already using the Hall technique in their practice, and among those not currently using it, there is a demand for training.

The Effect of an Increase in the Rate of Payment on General Practitionerss Intrinsic and Extrinsic Motivation

This paper investigates how the increased rate of Quality and Outcomes Framework (QOF) payments implemented on 1 April 2005 affects Scottish general practitioners’ (GPs) intrinsic, extrinsic and overall motivation. A first difference method is used to model GPs’ intrinsic and overall motivation. GPs’ extrinsic motivation is modelled using a probit model and Mundlak approach. The main finding is that the increased QOF payment effectively motivated GPs’ health care supply, but it also crowded out GPs’ intrinsic motivation. The results suggests that using strong financial incentives to further motivate already well-motivated health care professionals may have unintended effects on their performance.

Practice Nurse Appraisal: Evaluation Report

As general practice nurses (GPNs) now perform many activities formerly undertaken by general practitioners (GPs), the paperwork and process of the Scottish GP appraisal scheme may be usefully replicated for GPN appraisal. Eight GPNs adapted paperwork. Ten GP appraisers in NHS Lanarkshire were invited to interview their GPN(s) using the adapted paperwork. Both groups evaluated the project from 'descriptive' (participation and process) and 'reflective' or qualitative perspectives. Eight GPs appraised 11 GPNs using a ten-page document. GPNs reported that the documentation was helpful in preparing for and participating in the interview, as well as the planning of future objectives and development. GPs reported that the appraisal interview incorporated GPNs' views, the content was relevant, and their approach nonjudgemental and developmental. Some expressed concern that their participation had not helped them identify ways of addressing GPN learning needs. There was clear indication from GPNs that trained colleagues rather than GP employers are preferred appraisers. Improvements in the paperwork would be required. There is potential to replicate the paperwork and processes used in GP appraisal to GPNs, subject to refinement of the paperwork and engagement of trained nurse colleagues in the process. This may reduce the effect of collusion, inhibition or conflict of interest. However, GPN personal development still must be reconciled with practice priorities and development. The results of this pilot indicate a positive response in terms of participation and process. Further research should examine GPN appraisal using an external nurse appraiser, training issues and resource implications.

Scottish GPs use of homeopathy

The conclusions reached in the article by Ross et al.[1] are very unhelpful. In ‘What is already known about this subject’, you state: ‘Doctors and regulatory authorities have expressed concerns about their efficacy and safety’. What concerns have been expressed about the safety of homeopathic medicines? There are no published studies which have ever recorded harms from homeopathic medicines. To state that there are concerns about the safety of homeopathic remedies is erroneous and, I suspect, deliberately misleading. I wonder about the authors' motivation in conducting this study. They are clinical pharmacologists, after all, not experts in either Primary Care or Homeopathy, despite their claims to know better than the 60% of Scottish general practitioners (GPs) they accuse of acting either carelessly or inappropriately (see McLay's remarks as reported in the Glasgow Herald, 2 December 2006). It is considered to be good publishing practice to make a statement about conflicts of interest and funding, but, in this case, no such statement is declared.

The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners

BackgroundThe number of women working in general practice internationally has been steadily rising. In Scotland there have been concerns that such a change may lead to increased part-time working and subsequently to a fall in available general practice manpower despite an apparently rising overall number of general practitioners. However, there is very little information on the actual hours worked by men and women general practitioners or on the types of work they are undertaking.MethodsAnonymous workload questionnaires of all Scottish general practitioner principals and non-principalsResultsResponse rates for general practice principals and non-principals were 67.2% and 65.2% respectively. Male principals spent on average 18% more time on general medical services (GMS) and 50% more time on non-GMS activities (such as teaching, specialist sessions, administration and research) than women (both p <0.01). This difference was similar for non-principals. In no age group did the hours worked by women doctors approach that of male doctors.ConclusionWomen doctors in primary care in Scotland work fewer hours in all age groups than their male counterparts. The rapidly increasing proportion of women in general practice may lead to an increasing shortfall of medical availability in the future if current work patterns are maintained. Further longitudinal research is required to establish this and man-power planning is required now to address this. More worryingly auxiliary activities such as teaching and administrative duties are not being taken up by women. This may have serious implications for the future development of the specialty in Scotland.

Homoeopathic and herbal prescribing in general practice in Scotland

To investigate the current levels of homoeopathic and herbal prescribing in Scottish general practice. Prescribing of homoeopathic and herbal remedies in primary care was assessed in 1891 669 patients for the year 2003-2004, using computerized prescribing data retrieved from 323 general practices in Scotland. Forty-nine percent of practices prescribed homoeopathic and 32% herbal remedies. A total of 193 homoeopathic and 17 herbal remedies were prescribed, with 5% of practices accounting for 46% of patients and 50% of remedies. Four thousand one hundred and sixty patients (2.2/1000 registered patients) were prescribed at least one homoeopathic remedy during the study period, with the highest prevalence to children under 12 months of age (9.5/1000 children of that age). Children under the age of 16 made up 16% of the population prescribed homoeopathic remedies (2.2/1000 registered patients of that age). Three hundred and sixty-one patients (0.2/1000 registered patients) were prescribed at least one herbal remedy during the study period, 44 of whom were children < 16 years old. Patients prescribed a homoeopathic or herbal remedy were also prescribed a median of four and five conventional medicines, respectively. Of patients prescribed an oral herbal remedy, 4% were also concomitantly prescribed a conventional medicine with which a drug-herb interaction has been documented. Our study reports that a substantial number of Scottish general practitioners prescribe homoeopathic and herbal remedies, with an approximate doubling in the number of children prescribed homoeopathic remedies. The level of homoeopathic and herbal prescribing raises questions about homoeopathic/herbal provision in the National Health Service and should prompt critical review.