Managing multiple long-term conditions in people experiencing socioeconomic deprivation: a qualitative study of primary care perspectives
Eleanor Wyke, Elizabeth R Baxter, Carolyn A Chew-Graham, Abi Woodward, Kate Walters, Nathan Davies, Stephanie JC Taylor, Jamie Ross, Joanne Protheroe, Caroline Mitchell, Megan Armstrong
Background Multiple long-term conditions (MLTCs) are rising, especially among people experiencing socioeconomic deprivation, who develop MLTCs earlier and face barriers to self-management. Primary healthcare professionals (HCPs) are central to supporting self-management but face systemic challenges, resource inequalities, and emotional strain. Understanding their perspectives is vital to developing effective solutions. Aim To explore how HCPs in general practices in deprived areas support people to self-manage MLTCs, and the barriers to, and facilitators of, providing best levels of care. Design and setting This was a qualitative study with GPs, general practice nurses, advanced nurse practitioners, and allied health professionals working in socioeconomically deprived areas of two cities in England. Method Online semi-structured interviews were conducted with 18 HCPs from 17 general practices. Transcripts were analysed inductively, underpinned by elements of reflexive thematic analysis and grounded-theory methodology. A socioecological framework was applied retrospectively to situate HCP experiences within wider socioecological discourses. Results Four themes were identified: 1) individual factors influencing self-management, such as motivation and health literacy; 2) the role of social connections and community-based support; 3) enhancing primary care through continuity, longer appointments, and culturally sensitive, person-centred care; and 4) the impact of policy and inequitable funding on care provision. Key facilitators included accessible information, community signposting, and support navigating healthcare systems. Conclusion HCPs adapt care to meet patient needs but face systemic barriers, including underfunding and limited resources. Strengthening trust, cultural competence, and continuity of care, alongside policy and funding reform, is essential for delivering effective self-management support.