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

Recent evidence demonstrates persistence of the inverse care law (ICL) in general practice in England. Although the ICL was well-described in Scotland 20 years ago, progress in interventions since then is unclear.

To review national and local interventions that aimed to specifically address the ICL in Scottish general practice since 2000.

This was a systematic scoping review set in Scotland.

Embase, Web of Science, PubMed, CINAHL, Cochrane and BASE from 2000 to February 2024 were searched. A systematic grey literature search of government, NHS and third-sector websites was also performed. All papers were double screened for inclusion. Both quantitative and qualitative studies were included and quality was assessed using the Joanna Briggs Institute tools.

Out of 13 089 results, 67 papers reporting on 20 interventions were included. Interventions to improve general practice in deprived areas were categorised as: (a) enhancing patients' financial or social support, (b) targeting specific health conditions, (c) targeting specific groups, and (d) enhancing generalist health care. Six interventions accounted for 66% (44/67) of all included papers. Only two interventions have been rolled out nationally - community link workers and welfare advice and health partnerships - with both facing uncertain long-term funding.

There remains a major implementation gap between Scottish Government's policy ambitions to address health inequalities and sustainable delivery on the ground. To address the ICL, greater overall investment in general practice is needed, together with additional resources for more deprived areas according to local population need (a 'proportionate universalism' approach).