Patient satisfaction with general practice in Scotland: secular trends and association with deprivation, rurality and practice size-a secondary analysis of national survey data.

Abstract

To explore the relative contributions of practice size, socioeconomic deprivation and rurality to patient experience in Scotland and to examine temporal trends in patient satisfaction. Secondary analysis of repeated cross-sectional national survey data. Primary care in Scotland, using data from the Scottish Health and Care Experience (HACE) survey conducted biennially between 2009-2010 and 2021-2022, linked to publicly available national datasets. Data from 632 general medical practices (63% of the original 1008 participant practices) were analysed. Practices were excluded for reasons including potential closures or mergers, changes in urban-rural classification or missing population size data. Response rates were 16%-38%, highest in the most remote and least deprived areas. Practice-level percentage positive responses to seven HACE survey items, relating to patient-centred care and continuity of care, were assessed based on questions where respondents were asked to indicate their level of agreement. The relative importance method and regression models were used to examine the contribution of eightfold urban-rural classification, area deprivation quintile and practice size quintile to models of patient satisfaction within the latest dataset. Satisfaction levels captured by most questions remained broadly constant until 2019-2020, but there was a marked decline in reported satisfaction in the 2021-2022 survey. Participants in the more rural areas and patients registered with smaller practices consistently reported higher satisfaction levels over time. Participants registered with practices in more affluent areas expressed moderately higher levels of satisfaction in most domains. The relative importance analysis emphasised the dominant role of socioeconomic status and practice size in influencing patient satisfaction across most survey items (area deprivation accounting for up to 71% and practice population for up to 86% of explained variance for individual items), while rurality made a smaller contribution (5%-18%). Findings were confirmed in sensitivity analyses, excluding large practice size changes and minor changes in survey wording. Patient satisfaction underwent a marked decline after 2019-2020. Patients living in more rural and more affluent areas, and those registered with smaller practices, generally reported the highest levels of satisfaction. In the most recent survey, socioeconomic status and practice size were most strongly associated with patient satisfaction across most survey items. Further work is needed to clarify the mechanisms behind these findings.