General Practice and Primary Care

Tackling the inverse care law in Scottish general practice

The ‘inverse care law’ describes how people who most need health care are least likely to receive it. Research shows it applies to general practice in both Scotland and England.

This project explores the inverse care law in Scottish general practice. It analyses policies and interventions in Scotland since 2000 and presents the latest available data. It also draws on insights about the Scottish Deep End project – a collaboration between academic and front-line GPs working in the most deprived areas.

Since Scottish devolution in 1999, there have been numerous policy commitments to strengthening general practice in deprived areas. However, there remains a major implementation gap between policy ambitions to address health inequalities and sustainable delivery on the ground. Of the 20 interventions identified, few have received sustained investment. Only two – Community Link Workers and Welfare Advice and Health Partnerships – have been rolled out nationally in Scotland, but their future remains uncertain.

General practice funding per patient in the most deprived areas of Scotland is roughly equal to the least deprived areas, despite much higher levels of need. The most deprived areas also have both a smaller number of GPs and general practice workforce overall.

Policymakers in Scotland need to take steps ensure practices in more deprived areas are resourced in proportion to the needs of patients. Where interventions are working well, policymakers need to ensure long-term sustainable funding.

Read more about this work on The Health Foundation website