IT has long been surprising that investment in primary care services in areas of high deprivation is scarcely more than that spent on general practise in more affluent areas.
In the context of the well-rehearsed gulf between health outcomes for people in neighbouring Bearsden and Drumchapel, for example, this discrepancy could be seen as extraordinary. In parts of Scotland, according to the World Health Organisation, a distance of only eight miles can mean a reduced lifespan of 28 years.
Yet the phenomenon is well-recognised enough to have a name – the Inverse Care Law. This acknowledges that while GP practices in some of Scotland’s poorest communities receive a little more funding, the level of need in such areas mean that less is spent on the patients in most need than on those whose health and fitness is much better. In areas where patients are generally less fit from a younger age, often suffering from multiple co-morbidities, health inequalities are exacerbated rather than diminished.
So the Royal College of General Practitioners is right to argue that a £500 million boost for the NHS announced by Nicola Sturgeon last October could be used to invest in primary care and attempt to address this troubling problem.
The British Medical Association has an agreement with the Scottish Government that it will commissioning new research on general practice funding, pay and expenses. This is much needed.
There is already evidence that investing in GP care in deprived areas reaps dividends and extends lives.
While there is a case for reviewing the investment in all of primary care, the Government should look specifically at health inequalities in the context of general practice, focus on the kind of perverse outcomes represented by the Inverse Care Law and identify the most effective ways in which they can be addressed.
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