Addressing the inverse care law in Scottish general practice: systematic scoping review

Area of Science:

• Health Services Research
• Public Health Policy
• General Practice Management

Background:

• The inverse care law (ICL), where healthcare access is inversely proportional to need, persists in English general practice.
• While the ICL was documented in Scotland two decades ago, the effectiveness of subsequent interventions remains unclear.

Purpose of the Study:

• To systematically review national and local interventions implemented in Scottish general practice since 2000 aimed at addressing the inverse care law.
• To identify progress and challenges in tackling health inequalities within primary care settings in Scotland.

Main Methods:

• A systematic scoping review of multiple databases (EMBASE, Web of Science, MEDLINE, CINAHL, Cochrane, BASE) and grey literature from 2000 to February 2024.
• Inclusion of quantitative and qualitative studies, with quality assessment using Joanna Briggs Institute tools.
• Double screening of 13,089 identified results to select 67 papers reporting on 20 distinct interventions.

Main Results:

• Twenty interventions were identified, categorized into enhancing patient support, targeting specific conditions or groups, and improving generalist healthcare.
• Only two interventions, Community Link Workers and Welfare Advice and Health Partnerships, were implemented nationally, facing uncertain future funding.
• Six interventions dominated the literature, accounting for 49% of the included papers, indicating a focus on specific approaches.

Conclusions:

• A substantial implementation gap exists between Scottish Government policy goals for health equity and practical, sustainable delivery in general practice.
• Addressing the inverse care law requires increased overall investment in general practice.
• A 'proportionate universalism' approach, providing additional resources to more deprived areas based on local needs, is recommended for sustainable delivery.