Farhana Haseen is Lead Health Services Researcher for Healthcare Improvement Scotland
This article is also authored by colleagues from the Primary Care Improvement Portfolio, Healthcare Improvement Scotland, NHS Scotland, UK.*
[drocpap]C[/dropcap]ommunity Treatment and Care (CTAC) services were introduced as part of the 2018 General Medical Services (GMS)1 contract to increase capacity within general practice by transferring responsibility for the delivery of treatment room interventions from GP practices to NHS boards. Delivered through locally designed models, CTAC services vary across Scotland and include activities such as phlebotomy, chronic disease monitoring, wound care, ear care, and minor injury management. CTAC was also intended to enable General Practice Nurses (GPNs) to focus more on complex and chronic disease care. However, almost a decade later, an important question remains: what does successful CTAC implementation look like in practice, and how can its impact be demonstrated?
Covering a population of approximately 598,000 people, PCPIP examined not only how these services were implemented, but also the workforce, organisational, and system conditions required to achieve sustainable change in primary care.
The Primary Care Phased Investment Programme (PCPIP)2 provides valuable insights into the implementation of CTAC and pharmacotherapy services in Scotland. Commissioned by the Scottish Government and delivered by the Primary Care Improvement Portfolio at Healthcare Improvement Scotland, the programme was implemented across four areas – NHS Ayrshire & Arran, NHS Borders, a locality in Edinburgh City Health and Social Care Partnership (HSCP), and NHS Shetland. A distinctive feature of the programme was the combination of additional investment with structured quality improvement (QI) support, enabling teams to better understand local demand, to test changes, and adapt implementation approaches over time. Covering a population of approximately 598,000 people, PCPIP examined not only how these services were implemented, but also the workforce, organisational, and system conditions required to achieve sustainable change in primary care.
CTAC can support improvements in delivery of care
There were challenges in evaluating CTAC because services were at different stages of maturity across participating areas; some were establishing the service while others were expanding existing provision. Despite this variation, PCPIP findings suggest that additional investment in CTAC capacity can enhance service resilience, reduce appointment cancellations, improve access to treatment, and support more coordinated patient pathways. Although these benefits are likely driven in part by increased workforce capacity and resources, the learnings reinforce the policy rationale for CTAC and highlight the potential role of MDT-based models of care in supporting sustainable primary care.
Investment matters, but it is not enough
Perhaps the most important finding from PCPIP is that the main barriers to CTAC implementation were organisational and systemic rather than clinical. Inadequate infrastructure, including limited clinical accommodation, underdeveloped digital systems, and difficulties accessing reliable data, repeatedly constrained progress, even where additional investment was available. In several areas, progress was hindered by fragmented digital systems and limited interoperability. These challenges increased workload, delayed implementation, and, in some cases, impeded the development of seamless patient pathways between general practice and CTAC service.
Although funding created opportunities for improvement, investment alone was insufficient to achieve sustainable transformation. Greater progress was seen where funding was supported by strong leadership, local ownership, staff engagement, and structured quality QI support. Teams with protected time to understand demand, test changes, and use data for learning were better able to adapt and sustain improvement. These learnings suggest that the success of primary care reform depends not only on investment, but also on creating the conditions that enable improvement.
Workforce remains the critical challenge
The long-term sustainability of CTAC services depends on a capable, resilient, and well-supported workforce. Evidence from PCPIP highlights ongoing challenges related to workforce shortages, recruitment and retention difficulties, staff turnover, limited career progression opportunities, and the need for effective training, supervision, mentorship, and role clarity.
Successful implementation relied not only on workforce numbers but also on the right skill mix, supportive leadership, and access to professional development. Addressing these challenges is essential to maintain service continuity, quality of care, and the long-term resilience of CTAC services. PCPIP also highlighted the importance of clear career pathways, with stakeholders suggesting that CTAC nursing roles could provide a route into general practice nursing, supporting both workforce development and career progression.
There is no single CTAC model
A key lesson from PCPIP is that there is no single CTAC model that fits all settings. Participating areas adopted different approaches, including hub-based and practice-based models, reflecting local needs, workforce availability, geography, and existing service arrangements. Rather than hindering implementation, local adaptation often enabled services to respond effectively to local circumstances while maintaining the core aims of CTAC.
This has important implications for national policy. While consistency and equity of access remain important, overly standardised approaches may limit the flexibility needed to meet local needs. PCPIP findings suggest that policy should focus less on achieving a uniform model of implementation and more on creating the conditions that enable local systems to deliver effective services for their populations. Ultimately, success should be judged by improvements in outcomes, access, service resilience, and the effective use of resources, rather than by the uniformity of service models.
Access should not come at the expense of continuity of care
PCPIP findings suggest that policy should focus less on achieving a uniform model of implementation and more on creating the conditions that enable local systems to deliver effective services for their populations.
PCPIP highlighted concerns about continuity. Patients reported seeing multiple professionals, repeating information, and experiencing fragmented care pathways, while staff identified challenges in communication and coordination across MDTs. Given that continuity is strongly associated with better outcomes, patient satisfaction, and system efficiency, it is important that improvements in access do not come at the expense of continuity of care.
The lesson from PCPIP is not that CTAC threatens continuity, but that continuity requires active protection. Future service models should be designed to support both access and continuity, recognising them as complementary aspects of high-quality primary care.
Looking ahead
PCPIP demonstrates that CTAC services can strengthen primary care by improving access, supporting MDT working, and making better use of workforce skills. However, sustainable implementation requires more than investment alone. Workforce stability, infrastructure, leadership, quality improvement capability, meaningful data, and continuity of care are all essential to long-term success. Perhaps the most important lesson is that there is no single model for effective service delivery. Instead, future progress depends on creating the conditions that enable local systems to adapt, learn, and respond to the needs of their populations.
Deputy Editor’s note: Article submitted with permission from the Portfolio Lead for Primary Care, Healthcare Improvement Scotland
References:
- Scottish Government. (2017). GMS contract: 2018. https://www.gov.scot/publications/gms-contract-scotland/
- Healthcare Improvement Scotland. (2026). Primary Care Phased Investment Programme: Final Report. Healthcare Improvement Scotland. https://www.healthcareimprovementscotland.scot/publications/primary-care-phased-investment-programme-reports-june-2026/
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