The Inverse Care Law

Deep End Report 2 summarises GP views on needs and resources in general practice in very deprived areas.

REPORT 2 Coping with needs, demands and resources (Jan 2010)
Summary | Full report

A letter from the Balmore Practice at Possilpark Health Centre to the Chief Executive of the City of Glasgow Health and Social Care Partnership in July 2015 described the challenges facing the practice serving the third most deprived practice population in Scotland.

Letter from a Deep End practice (July 2015)‌

A short article in the British Journal of General Practice describes a day at work for a general practitioner serving the most derived practice population in Scotland.

Watt, G. (2015) Discretion is the better part of general practice. British Journal of General Practice 65(635), p. 306. (doi:10.3399/bjgp15X685357) (PMID:26009518) 

Deep End Report 20 How Can NHS Scotland Prevent and Reduce Health Inequalities? and a subsequent short article in the BJGP summarise and explain actions which can be taken to address the Inverse Care Law.

REPORT 20 What can NHS Scotland do to prevent/reduce health inequalities? (Apr 2013)
Summary | Full report

Watt G. What can the NHS do to prevent and reduce health inequalities? British Journal of General Practice 2013 63 (614), 494-495. doi:10.3399/bjgp13X671803

The latest lobbying document is 

REPORT 30 A role for Members of the Scottish Parliament in addressing inequalities in healthcare in Scotland (Nov 2016) 

Relevant research articles

This essay reviewed the current relevance, importance and mechanisms of the Inverse Care Law, over 40 years after its first publication.

Watt, G.C.M. (2002) The inverse care law today. Lancet, 360, pp. 252-254. (doi:10.1016/S0140-6736(02)09466-7)

The next two papers describe the distribution of general practices by decile of the distribution of socio-economic deprivation in Scotland and associations with a range of practice activities.

Mackay, D., Sutton, M., and Watt, G. (2005) Deprivation and volunteering by general practices: cross sectional analysis of a national primary care system. British Medical Journal, 331(7530), pp. 1449-1451. (doi:10.1136/bmj.331.7530.1449)

Mackay, D.F., and Watt, G.C.M. (2010) General practice size determines participation in optional activities: cross-sectional analysis of a national primary care system. Primary Health Care Research and Development, 11(3), pp. 271-279. (doi:10.1017/S1463423610000058)

The next two papers describe the implications of the inverse care law in Scotland, based on 3000 GP consultations and 700 videoed consultations.

Mercer, S.W., and Watt, G.C.M. (2007) The inverse care law: clinical primary care encounters in deprived and affluent areas of Scotland. Annals of Family Medicine, 5, pp. 503-510. (doi:10.1370/afm.778)

Mercer, S. W., Higgins, M., Bikker, A. M., Fitzpatrick, B., McConnachie, A., Lloyd, S. M., Little, P., and Watt, G. C. M. (2016) General practitioners empathy and health outcomes: a prospective observational study of consultations in areas of high and low deprivation. Annals of Family Medicine, 14(2), pp. 117-124. (doi:10.1370/afm.1910) (PMID:26951586)

This paper describes the generally flat distribution of GP funding per patient per annum, especially in the more deprived 50% of the Scottish population.

McLean, G., Guthrie, B., Mercer, S.W., and Watt, G.C.M. (2015) General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland. British Journal of General Practice, 65(641), e799-e805. (doi:10.3399/bjgp15X687829)