Responses to the inverse care law in Scotland over the last 20 years

In 1971, Julian Tudor Hart defined the inverse care law as ‘the availability of good medical care tends to vary inversely with the need for it in the population served’.  Evidence suggests the inverse care law is still going strong. Although the inverse care law can apply in all health care settings, primary care is particularly important, due to its key role in the NHS in terms of improving or maintaining health for the whole population.

An important ‘ground-up’ response to the challenges of the inverse care law emerged over a decade ago in the form of the ‘GPs at the Deep End’ group, comprising general practitioners working in the 100 most socioeconomically deprived practices in Scotland. The group has involved collaboration between front-line and academic GPs, and other colleagues, to mitigate the impact of health inequalities, through advocacy, evidence, service development, and professional development. Learning from the previous work done by the Scottish Government and Health Boards, as well as the GPs at the Deep End, may help to inform primary care policy and practice in the UK and internationally. Fifty years since Tudor Hart’s seminal paper, it is timely to take stock of the key lessons in Scotland relating to responses to the inverse care law.

The project aims to: 

• understand how the inverse care law has manifested in Scotland over the past 20 years in primary health care  
• map out the range of interventions and approaches (at national, regional and local levels) that have been deployed to tackle the inverse care law in Scotland, and the rationale behind them
• review the evidence of the impact and sustainability of these interventions and approaches, including the role of the Deep End GP project in Scotland
• synthesise what has worked and what has not worked in reducing the inverse care law in Scotland, and to make recommendations for future directions.

The research will be completed in February 2023.

Contact details

David Blane – David.Blane@glasgow.ac.uk

Becks Fisher – Rebecca.Fisher@health.org.uk