Responses to the inverse care law in Scottish general practice and the role of the Deep End project: a qualitative study

Background General practitioners (GPs) working in areas of high deprivation in Scotland formed the ‘Deep End’ group in 2009 in response to the well-documented inverse care law (ICL).

Aim To understand the views and experiences of key stakeholders about responses to the ICL in general practice in Scotland over the past 20 years, and the impact of the Scottish Deep End Project.

Design & setting Qualitative study with key primary care stakeholders (n=17) in Scotland, UK.

Method Semi-structured interviews.

Results Five main themes were identified, reflecting participants’ experiences of working in deprived areas and their views on the role of the Deep End. These themes describe how existing measures fall short of addressing the ICL, how intersecting disadvantage complicates service responses, and how sustainability, professional identity, and collective voice shape efforts to improve care in disadvantaged communities. A key recommendation was greater investment in primary care generally, but with graded additional resources for more deprived areas depending on need (a “proportionate universalism” approach).

Conclusion Despite widening health inequalities, and the long-standing evidence of the ICL in general practice in deprived areas, there is a paucity of enduring policies and interventions to tackle the ICL in Scotland. The Scottish Deep End group has created a distinctive platform for general practitioners to collectively challenge the inverse care law. Practitioner-led networks can play an essential role in addressing health inequalities, supporting professionals, and informing policy.