A team from the University of Glasgow is to work with Stirling and Dundee universities as well as four GP practices to develop new ways to work with patients.

Funded by the Scottish Government, the £820,000 Living Well with Multiple Morbidity programme will focus on those in deprived areas where such conditions are more common, strike earlier and tend to have a disproportionate impact on people’s quality of life.

Researchers will investigate a range of measures that could help patients with multiple morbidity – two or more co-existing medical conditions – to manage their conditions and improve quality of life. It will also look at how changes to the NHS primary care system could improve care for patients and make practices more efficient.

Lead researcher Professor Stewart Mercer, chair of primary care research in the department of general practice and primary care at the University of Glasgow, said GPs were best placed to manage patients with multiple conditions, but that the four-year project would be taking a radical look at how services are presently organised. He said: “None of this can be done without substantial change in how care is delivered.”

Multiple morbidity is an increasingly common problem in Scotland, particularly in areas of high deprivation, and affects psychological as well as physical wellbeing. As many as two-thirds of patients in deprived areas of Glasgow who consult their GPs about a long-term condition have three or more co-existing conditions.

It is an under-researched area but becoming one which health systems internationally are more interested in. “The theme has been adopted by the Scottish School of Primary Care, and other countries like the US, Canada and England are also making it an explicit research theme,” Mercer added. “For GPs, it is sometimes hard to know where to begin with multiple morbidities, because there can be so many things going on.”

The NHS response is also complicated by other factors. Scotland has increasing numbers of people with long-term conditions, and multiple morbidity is the norm rather than the exception in deprived areas. However, Mercer said some conditions – such as arthritis, irritable bowel syndrome and back pain – are not included in the Quality and Outcomes Framework which offers extra incentives to GPs for tackling only major conditions such as heart disease.

The issue also goes to the heart of the built-in inequality in the health service, known as the inverse care law. This recognises the fact that NHS resources are distributed equally, regardless of density of need. The same number of GPs serve a wealthy area as a deprived one. “While the health needs may be three times higher in a poor area of Glasgow, for instance, areas of high need don’t get an increased amount of service. So primary care services are most overstretched in the areas where they are most needed.”

Given that patients with more than one illness are more likely to visit their doctor regularly, it is hoped the project will reduce the burden on those GPs who face the greatest demand.

The four-year study will focus on patients aged 40-65 in deprived areas and measure levels of multiple morbidity, assessing both the conditions and the combinations of conditions which are most worth targeting. The team will develop a range of interventions and then conduct a feasibility test to assess their potential effectiveness, with randomised controlled trials.

Possible interventions could include changes to the GP appointments system, making consultations longer, providing continuity of care, training and support for GPs and nurses and providing self help resources such as books and CDs for use at home so patients can recognise when they are able manage symptoms of their conditions at home.

Prof Mercer said: “Primary healthcare teams – GPs, primary and community care nurses and other health professionals – are often in the best position to help people manage their complex multiple health problems, but there is little research about what combination of help is most likely to work and why.

“What we do know is that help and support is most likely to work when it is based around individuals’ own needs and problems and when they have an active role in managing their conditions better.”

The model will not be the expert patients programme developed by the NHS in England, which has had limited success, he added.

“That hasn’t been a rip roaring success and the improvements achieved are quite small. It also attracts a more middle class audience. In deprived areas, people are less likely to go along to self help workshops. We want to do something right in the middle of family care and general practice, where patients do go.”

A health economist will be part of the team and cost effectiveness will be a key goal, Mercer said. “If what we come up with is successful it could be rolled out on a national scale, but if the outcome is that it is slightly effective, but very costly, it would go no further.”