Addressing the Inverse Care Law in Scottish general practice: systematic scoping review.

Abstract

Background 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. Aim To review national and local interventions which aimed to specifically address the ICL in Scottish general practice since 2000. Design & Setting Systematic scoping review, Scotland. Method We searched EMBASE, Web of Science, MEDLINE, CINAHL, Cochrane and BASE from 2000 to February 2024. We also performed a systematic grey literature search of government, NHS and third sector websites. All papers were double screened for inclusion. We included quantitative and qualitative studies and assessed quality using the Joanna Briggs Institute tools. Results Out of 13089 results, 67 papers reporting on 20 interventions were included. Interventions to improve general practice in deprived areas were categorised as: 1) enhancing patients' financial or social support, 2) targeting specific health conditions, 3) targeting specific groups and 4) enhancing generalist healthcare. Six interventions accounted for 49% 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. Conclusion 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 inverse care law, 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).