Cardiovascular Disease Directed Enhanced Service: views and experiences of General Practices

Annex B: Method statements

Survey

The online survey (attached at Annex A) comprised 29 questions covering NHS Board and GP practice details, programme delivery and implementation, and experiences of implementing the programme. It included both closed-ended and open-ended questions exploring awareness of the programme and receipt of training, use of clinical tools and pathways (including ASSIGN and ESCRO), approaches to identifying and engaging eligible patients, and perceptions of the programme’s impact on workload and practice operations.

Practices were also given the opportunity to opt into a follow-up interview to discuss their experiences in more detail and contribute to a qualitative research project.

Quantitative analysis

Responses to closed-ended survey questions were summarised. Survey data was downloaded from Microsoft Forms and the automatically generated response summaries were reviewed against independently calculated frequencies in Excel to ensure accuracy.

Where practices submitted more than one survey response, only the earliest response was retained, resulting in a final analytical sample of 162 responses from 162 unique practices.

Free-text responses grouped by Microsoft Forms under ‘Other’ categories were reviewed and recoded where appropriate to improve the categorisation and interpretation of responses. Counts were then used to summarise response patterns and generate bar charts.

Supplementary subgroup analyses

Supplementary subgroup analyses were undertaken to provide additional insights when considered useful. These included breakdowns by deprivation, urban/rural classification and NHS Board.

One responding practice, which specialises in providing healthcare for adults experiencing homelessness, was excluded from the deprivation and urban/rural analyses because no patient demographic data was available. As a result, these analyses are based on 161 responses, whereas the overall survey findings are based on 162 responses from practices.

For the purposes of supplementary analyses, the following approaches were used:

• Deprivation analysis: practices were classified as serving a more deprived than average population where more than 20% of their registered patients lived in the 20% most deprived data zones, as recorded in the Scottish Index of Multiple Deprivation (SIMD). This included 64 of the 161 responding practices (40%). The remaining 97 of 161 (60%) practices had less than 20% of their registered patients lived in the 20% most deprived data zones.
• Urban/rural analysis: practices were classified as serving a more rural than average population where more than 16% of their registered patients lived in rural areas, reflecting the proportion of Scotland's GP patient population living in rural areas, as defined by the Scottish Government Urban Rural Classification. This included 60 of the 161 responding practices (37%). The remaining 101 of 161 practices (63%) had less than 16% of their registered patients lived in rural areas.
• NHS Board analysis: practices were classified by the NHS Board in which they were based. Responses were received from practices representing 12 of the 14 Scottish territorial NHS Boards.

Qualitative analysis

Responses to open-ended responses were analysed using a thematic analysis approach to explore the range and diversity of experiences of implementing the programme. The focus was on understanding the nature and meaning of practices' experiences.

Free-text responses were reviewed and coded inductively to identify recurring patterns and issues raised by practices. Initial descriptive codes were grouped into broader themes through an iterative process of comparison and refinement, with themes reviewed to ensure they reflected distinct concepts. Individual responses could contribute to multiple themes, reflecting the breadth of issues often raised within a single response. Illustrative quotations are included throughout to provide examples of the themes identified.

Survey representativeness assessment

The survey was distributed through Primary Care Leads, who were asked by the Scottish Government Primary Care policy team to circulate the invitation within their respective networks. While this approach enabled rapid dissemination across GP practices in Scotland, it was not possible to determine the extent to which the invitation reached all practices. Consequently, a response rate could not be calculated.

A total of 164 survey responses were received from GP practices in Scotland. With the exception of two practices that submitted two responses each, all practices submitted a single response. As the survey was intended to capture one response per practice, only the earliest response was retained where more than one submission was identified. The final sample comprised 162 GP practices.

As of 1 April 2026, there were 880 GP practices in Scotland^[22]. Responding practices were compared with national GP registered population data to assess the representativeness of the survey sample by Health Board, deprivation (Scottish Index of Multiple Deprivation; SIMD) and urban-rural classification.

Interviews

Purpose and research questions

The Scottish Government (SG) commissioned an independent research company (Craigforth) to undertake qualitative research with primary care practitioners to inform the monitoring and evaluation of the Cardiovascular Disease Directed Enhanced Service (CVD DES). The research was expected to focus on:

• Understanding the choices that practices have made when participating in and implementing the CVD DES
• Whether they have felt sufficiently supported in their involvement with the DES
• What they feel is working well and where there is room for improvement
• The extent to which practices feel that they are reaching the target population and making a difference through delivery of policy and practice focused outputs.

The information gathered was to help the Scottish Government better understand how the service has been implemented in practice, what is going well and where there are areas for improvement. It was expected to complement the quantitative data being gathered from General Practices by the Scottish Government itself.

It was envisaged that semi-structured interviews with a general practitioner from each of approximately 20 - 30 General Practices would be undertaken, with the Scottish Government Primary Care Division assisting in identification and recruitment of practices.

Approach

Set up and recruitment

A semi-structured interview was developed; this was informed by draft findings from the online survey (the quantitative component referenced above) and discussions with the Research Advisory Group (RAG). The membership of the RAG was:

• Karen Macpherson, Principal Social Researcher, Scottish Government
• Christiana Stergiou, Social Research Officer, Scottish Government
• Stuart Reary, Senior Medical Advisor on General Practice Policy, Scottish Government
• Mathew Saunders, Consultant in Public Health, Public Health Scotland and Greater Glasgow and Clyde
• Dorien Kimenai, BHF Intermediate Research Fellow, Epidemiologist, University of Edinburgh
• Iona Lyell, Public Health Registrar and Clinical Research Fellow, University of Edinburgh

Recruitment materials were also developed and agreed; these included a privacy notice and consent form.

The Scottish Government passed on summary information (practice name and contact details etc.) for the 40 practices who completed the survey and indicated that they would be willing to participate in follow up research.

Initial email requests to take part were issued to 30 practices (selected to give a good spread across size, location and level of deprivation etc.). Not all of those practices went on to participate, with requests for interview being sent to the remaining 10 practices.

Those who agreed to take part were sent a link to a 45-minute TEAMS meeting, as well as information about consent and a request to record the interview.

Interviews

Interviews took place between 9 June and 8 July 2026, with 31 interviews completed. All interviews were conducted online and all participants agreed to be recorded.

In most cases, there was a single representative from the practice at the interview, but in two cases, two people participated. Interview length ranged from 30 to 55 minutes, with around 40 minutes the most usual.

Once the interview had been completed, a transcript was created and the original recording deleted.

As is standard practice in research with General Practice, each Practice received a payment to cover the time spent participating. This was administered through the National Research Scotland Primary Care Network.

Analysis and reporting

Framework analysis was used to ensure a systematic and structured approach. A draft analysis framework, structured around the research questions and final research tools (i.e. the interview schedule), was developed.

The focus was on producing an account of the full range of experiences and views from practices, identifying any relevant examples or case studies, and highlighting cross-cutting themes. This included whether there may have been a relationship between experiences/views about the CVD DES and practice profile (for example whether in an urban or rural area etc.).

Based on discussions with the RAG, it was decided that the quantitative (survey) and qualitative components would be presented together in a single research findings report.

A write up of the survey results was produced by the Scottish Government. This was shared with Craigforth who then produced the full report, including by adding in their analysis from the interviews. To aid the integration, the results of the survey may not be presented in the same order in which the questions were set out originally.

The analysis of the interviews reflects the qualitative nature of that strand, although occasional references may be made to frequently made points; to be frequently made requires the point to have been made by at least 1 in 5 interviewees (i.e. 6 interviewees or more).

Where notable or relevant, the interviews findings may note the role of the interviewee within their practice i.e. whether a GP, Practice Manager or Other Health Professional. The interview findings may also highlight any features of an interviewee’s practice that may be helpful in setting their views or experiences in context for example in terms of practice size, whether in an urban or rural area, relative levels of deprivation etc.

Observations from the qualitative research team

Having completed the analysis and reporting phases, and reflected on the research process and findings overall, the qualitative research team have some general observations which it may be helpful to share with readers.

First, the findings from the interviews are broadly in line with the survey findings, albeit potentially tending to the slightly more positive view overall. In general terms, this is to be expected since the interviewees are a mainly a subset of survey respondents. The potentially more positive perspective may be a function of being willing to contribute further time to the research but also that none of the practices which did not take part in the CVD DES took part in an interview.

The profile of practices taking part was varied in terms of the size of their list and location, as well as the socio-economic profile of the area they cover. Although these variations sometimes informed interviewees views on different aspects of the CVD DES (for example, the weighting based on proportion of the list living in SIMD 1 or 2), overall, there were few if any clear patterns based on the profile of the practice. Interviewees themselves sometimes also noted that it was not clear why, for example, a particular engagement approach may or may not have worked for their practice.

In terms of the role of the interviewee within the practice, there were some slight variations, most obviously that GPs and other health professionals may have been more expansive around clinical assessment for example, while practice managers may have had greater awareness around some of the practical challenges encountered, especially around patient engagement. Overall, however, interviewees tended to have a good general understanding of how their practice had found it to deliver the 2025 to 2026 CVD DES.

Given these general observations relating to profile of the practice and the role of interviewee, the report only references the interviewees’ role when there was a clear link to the research finding presented.