Needs assessment in primary care: general practitioners' perceptions and implications for the future

Background. Health, needs assessment can guide the appropriate shift to pri mary care by identifying the most effective and efficient resource allocati on to meet the needs of populations. Assessing health care needs will be a continuing challenge for primary care trusts in Scotland (or equivalent gro ups in other parts of the United Kingdom); however, lessons must be learned from the experience of needs assessment that followed the 'internal marker ' reforms of the 1990s. Aim. To examine general practitioners' (GPs') awareness and experience of n eeds assessment, to identify barriers to needs assessment in primary care, and to ascertain how better progress might be made in the future. Method. A postal questionnaire survey of 1777 Scottish GPs (a one-in-two sa mple) was combined with a semistructured interview survey of 'lead' GPs fro m a random sample of 64 mainland Scottish practices between May and August 1996 Results. Sixty-five per cent (1154) of GPs responded to the questionnaire, of which 54% (965) were completed. Over 73% (47) of interviews were complet ed. Most GPs were unfamiliar with the concept of needs assessment and there was no evidence that needs assessment had influenced commissioning decisio ns. Most GPs argued that it was not a 'core' activity and that they lacked training in the relevant skills. While the attitude of the majority was ind ifferent, cynical, and sometimes hostile, a minority, comprising mostly you nger fundholders, was more enthusiastic about needs assessment. Conclusion. The motivation and attitude of the majority of GPs present a ba rrier to needs assessment in primary care. GPs will require more resources and training if they are to undertake this responsibility. Most GPs believe than incentives (financial or organisational) will be necessary. Primary c are trusts and equivalent structures should be aware of these attitudes as they seek to establish plans based an estimates of population needs in defi ned locations.