Health inequalities, multimorbidity, and primary care in Scotland

Scotland has an ageing population and the widest health inequalities in Western Europe. Multiple health conditions develop ∼10–15 years earlier in deprived areas than in affluent areas. General practice is central to the effective and safe management of such complex multiple health conditions, but the inverse care law has permeated deprived communities (‘Deep End’ general practices) for the past 50 years. A new, radical, Scottish GP contract was introduced in April 2018, which has a vision to improve quality of care through cluster working and expansion of the multidisciplinary team (MDT), enabling GPs to deliver ‘expert generalism’ to patients with complex needs. It states a specific intention to address health inequalities and also to support the integration of health and social care. Here, we discuss recent evidence for whether the ambition of the new GP contract, to reduce health inequalities, is being achieved

Many people in Scotland now benefit from anticipatory care before they die: an after death analysis and interviews with general practitioners

Background Key Information Summaries (KIS) were introduced throughout Scotland in 2013 so that anticipatory care plans written by general practitioners (GPs) could be routinely shared electronically and updated in real time, between GPs and providers of unscheduled and secondary care. Aims We aimed to describe the current reach of anticipatory and palliative care, and to explore GPs\u27 views on using KIS. Methods We studied the primary care records of all patients who died in 2014 in 9 diverse Lothian practices. We identified if anticipatory or palliative care had been started, and if so how many weeks before death and which aspects of care had been documented. We interviewed 10 GPs to understand barriers and facilitating factors. Results Overall, 60% of patients were identified for a KIS, a median of 18 weeks before death. The numbers identified were highest for patients with cancer, with 75% identified compared with 66% of those dying with dementia/frailty and only 41% dying from organ failure. Patients were more likely to die outside hospital if they had a KIS. GPs identified professional, patient and societal challenges in identifying patients for palliative care, especially those with non-cancer diagnoses. Conclusions GPs are identifying patients for anticipatory and palliative care more equitably across the different disease trajectories and earlier in the disease process than they were previously identifying patients specifically for palliative care. However, many patients still lack care planning, particularly those dying with organ failure

GPs at the Deep End Report 39: Prison health

On Wed 9 March 2022, the Deep End GP group hosted an online roundtable meeting to explore the challenges of delivering high quality primary health care in Scotland’s prisons. Discussion centred on the various systemic factors that affect the organisation and delivery of care, as well as issues with recruitment and retention of GPs in Prison health, but also explored potential system-wide solutions to these issues

GPs at the Deep End Report 40: What can general practice do to mitigate the effects of the cost-of-living crisis?

On Wednesday 30 November 2022, the Deep End GP group hosted an online roundtable meeting to explore the challenges of the cost-of-living crisis. Discussion centred on the various specific challenges, but also explored potential system-wide solutions to these issues

General practice post-COVID-19: time to put equity at the heart of health systems?

No abstract available

Is Scotland’s new GP contract addressing the inverse care law?

Scotland, like many countries around the world, has wide health inequalities due in part to the longstanding ‘inverse care law’ in which a mismatch between patient needs and provision of care in general practice in deprived areas results in poorer care and worse patient outcomes compared with affluent areas. In early 2018, Scotland embarked on a new GP contract, a stated aim of which was to reduce healthcare inequalities. National data on avoidable mortality showed a 4.8 (2019) and 4.9 (2021) fold higher rate in the most deprived compared with the most affluent decile of the population. However, the distribution of whole-time equivalent (WTE) general practice clinicians per 10,000 patients - including GPs, and practice-employed practice nurses and other allied healthcare professionals - showed the opposite trend in both 2019 and 2022, with fewer WTE clinicians of all types in GP practices in deprived areas compared with affluent areas. These findings suggest that radical change is needed to reverse the inverse care law in Scotland.[141 words]Keywords: primary care; inequalities; Scotland<br/