Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

The Deep End GP Pioneer Scheme: a qualitative evaluation

Safiya Dhanani A and David N. Blane https://orcid.org/0000-0002-3872-3621 B *
+ Author Affiliations
- Author Affiliations

A School of Medicine, Dentistry and Nursing, Wolfson Medical School, University of Glasgow, University Avenue, Glasgow, Scotland, UK.

B General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, Scotland, UK.

* Correspondence to: david.blane@glasgow.ac.uk

Australian Journal of Primary Health 29(2) 155-164 https://doi.org/10.1071/PY22162
Submitted: 29 July 2022  Accepted: 7 September 2022   Published: 12 October 2022

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background: The Scottish Deep End Project is a collaboration between academic GPs and GPs in practices serving the most socio-economically disadvantaged populations in Scotland. The Deep End GP Pioneer Scheme was established in 2016 to improve GP recruitment and retention in these areas. The aim of this study was to qualitatively evaluate the experiences of participating lead GPs and GP fellows.

Methods: Semi-structured interviews were conducted with nine lead GPs and 10 GP fellows, representing 12 of the 14 practices involved. Interviews were audio-recorded, transcribed verbatim, and analysed thematically.

Results: Five main themes are presented: Recruitment to the Pioneer Scheme; Work motivation and satisfaction; Mitigating health inequalities; Retention and changes in work pattern; and Suggestions for the future. Key ingredients of the scheme were the additional clinical capacity (addressing the inverse care law), protected time for both GP fellows and experienced GPs to lead on service development initiatives and to share learning within and between practices, and the shared ethos and values of the Scheme.

Conclusions: There was strong support for the Scheme as a mechanism to improve GP recruitment and retention in areas of high socio-economic disadvantage, and to improve quality of care in these areas. As similar schemes are rolled out across the UK, there is a need for further research to evaluate their impact on workforce and patient outcomes in deprived areas.

Keywords: general practice, health inequalities, inverse care law, primary care, professional development, qualitative, quality improvement, workforce.


References

Babbel B, Mackenzie M, Hastings A, Watt G (2019) How do general practitioners understand health inequalities and do their professional roles offer scope for mitigation? Constructions derived from the deep end of primary care. Critical Public Health 29, 168–180.
How do general practitioners understand health inequalities and do their professional roles offer scope for mitigation? Constructions derived from the deep end of primary care.Crossref | GoogleScholarGoogle Scholar |

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet 380, 37–43.
Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |

Blane DN (2018) Medical education in (and for) areas of socio-economic deprivation in the UK. Education for Primary Care 29, 255–258.
Medical education in (and for) areas of socio-economic deprivation in the UK.Crossref | GoogleScholarGoogle Scholar |

Blane DN, McLean G, Watt G (2015) Distribution of GPs in Scotland by age, gender and deprivation. Scottish Medical Journal 60, 214–219.
Distribution of GPs in Scotland by age, gender and deprivation.Crossref | GoogleScholarGoogle Scholar |

Blane DN, Sambale P, Williamson AE, Watt GCM (2017) A change model for GPs serving deprived areas. Annals of Family Medicine 15, 277
A change model for GPs serving deprived areas.Crossref | GoogleScholarGoogle Scholar |

Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77–101.
Using thematic analysis in psychology.Crossref | GoogleScholarGoogle Scholar |

Bravo R, Catalán S, Pina JM (2021) Gamification in tourism and hospitality review platforms: how to R.A.M.P. up users’ motivation to create content. International Journal of Hospitality Management 99, 103064
Gamification in tourism and hospitality review platforms: how to R.A.M.P. up users’ motivation to create content.Crossref | GoogleScholarGoogle Scholar |

Fairhealth (2022) GP Trailblazer programme. (Fairhealth) Available at https://www.fairhealth.org.uk/trailblazer

Fisher R, Allen L, Malhotra AM, Alderwick H (2022) Tackling the inverse care law: analysis of policies to improve general practice in deprived areas since 1990. (The Health Foundation: London). Available at https://www.health.org.uk/publications/reports/tackling-the-inverse-care-law

Mackenzie M, Skivington K, Fergie G (2020) “The state They’re in”: unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities. Social Science & Medicine 256, 113047
“The state They’re in”: unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities.Crossref | GoogleScholarGoogle Scholar |

MacVicar R, Williamson A, Cunningham DE, Watt G (2015) What are the CPD needs of GPs working in areas of high deprivation? Report of a focus group meeting of ‘GPs at the Deep End’. Education for Primary Care 26, 139–145.
What are the CPD needs of GPs working in areas of high deprivation? Report of a focus group meeting of ‘GPs at the Deep End’.Crossref | GoogleScholarGoogle Scholar |

Marczewski A (2013) The intrinsic motivation RAMP. (Gamified UK) Available at https://www.gamified.uk/gamification-framework/the-intrinsic-motivation-ramp/

McCallum M, MacDonald S, McKay J (2019) GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study. BJGP Open 3,
GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study.Crossref | GoogleScholarGoogle Scholar |

McCallum M, Hanlon P, Mair FS, Mckay J (2020) Is there an association between socioeconomic status of General Practice population and postgraduate training practice accreditation? A cross-sectional analysis of Scottish General Practices. Family Practice 37, 200–205.
Is there an association between socioeconomic status of General Practice population and postgraduate training practice accreditation? A cross-sectional analysis of Scottish General Practices.Crossref | GoogleScholarGoogle Scholar |

McLean G, Guthrie B, Mercer SW, Watt GCM (2015) General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland. British Journal of General Practice 65, e799–e805.
General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland.Crossref | GoogleScholarGoogle Scholar |

Mercer SW, Watt GCM (2007) The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. The Annals of Family Medicine 5, 503–510.
The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland.Crossref | GoogleScholarGoogle Scholar |

Mercer SW, Jani BD, Maxwell M, Wong SYS, Watt GCM (2012) Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland. BMC Family Practice 13, 6
Patient enablement requires physician empathy: a cross-sectional study of general practice consultations in areas of high and low socioeconomic deprivation in Scotland.Crossref | GoogleScholarGoogle Scholar |

O Carroll A, O’Reilly F (2019) Medicine on the margins. An innovative GP training programme prepares GPs for work with underserved communities. Education for Primary Care 30, 375–380.
Medicine on the margins. An innovative GP training programme prepares GPs for work with underserved communities.Crossref | GoogleScholarGoogle Scholar |

Russell M, Lough M (2010) Deprived areas: deprived of training? British Journal of General Practice 60, 846–848.
Deprived areas: deprived of training?Crossref | GoogleScholarGoogle Scholar |

Ryan RM, Deci EL (2000) Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist 55, 68–78.
Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being.Crossref | GoogleScholarGoogle Scholar |

Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, Burroughs H, Jinks C (2018) Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & Quantity 52, 1893–1907.
Saturation in qualitative research: exploring its conceptualization and operationalization.Crossref | GoogleScholarGoogle Scholar |

Scottish Government (2022) Primary Care Health Inequalities Short-Life Working Group: report. (Scottish Government). Available at https://www.gov.scot/publications/report-primary-care-health-inequalities-short-life-working-group/

Tong A, Sainsbury P, Craig J (2007) Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19, 349–357.
Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.Crossref | GoogleScholarGoogle Scholar |

Tudor Hart J (1971) The inverse care law. The Lancet 297, 405–412.
The inverse care law.Crossref | GoogleScholarGoogle Scholar |

Watt G, Deep End Steering Group (2011) GPs at the Deep End. British Journal of General Practice 61, 66–67.
GPs at the Deep End.Crossref | GoogleScholarGoogle Scholar |