What interventions have addressed the inverse care law in general practice in Scotland over the last 20 years? A systematic scoping review.

Abstract

Recent evidence demonstrates persistence of the inverse care law (ICL), with fewer GPs and less funding in more deprived areas. To map out interventions that aimed to address the ICL and the rationale behind them, and to review the impact and sustainability of these interventions - what has worked, for whom, and why? The authors searched Embase, Web of Science, MEDLINE, CINAHL, Cochrane, and BASE from 2000 to 2022 for articles describing interventions or policies that aimed to address the ICL in general practice in Scotland. A systematic grey literature search of government, NHS, and third-sector websites was also performed. All articles were double screened for inclusion. Quantitative and qualitative studies were included. Other forms of primary care, such as dental or pharmacy, were not included. There were 77 included articles (35 from the database search and 42 from the grey literature) reporting on 20 interventions. Interventions were categorised as: 1) enhancing financial or social support; 2) targeting specific health conditions; 3) holistic interventions targeting specific populations; and 4) enhancing generalist care. Seven key interventions accounted for over 70% of all included articles. Evidence of impact and sustainability was variable. Key lessons were summarised for each intervention and grouped by category. To address the ICL, a key recommendation is for greater investment in general practice as part of the overall NHS spend, with graded additional resources for more deprived areas depending on local population need (a 'proportionate universalism' approach).