Inclusion Health Action in General Practice (IHAGP): evaluation

Executive Summary

The Inclusion Health Action in General Practice (IHAGP) programme was introduced by the Scottish Government in 2023. IHAGP provides GP practices in areas of high deprivation with additional investment to undertake practical action to address healthcare inequalities which impact health inequalities. It supports these practices to deliver more inclusive, proactive, and patient-centred care, under three key themes (as outlined below).

This second-stage evaluation builds on an earlier process review^[1] and focuses on emerging outcomes, patient perspectives, and lessons for sustainability.

Policy Context

Health inequalities remain one of Scotland’s most pressing challenges, disproportionately affecting people in socioeconomically deprived communities. IHAGP was developed in response to recommendations in the 2022 report by the Short Life Working Group on Health Inequalities in Primary Care. It aligns with national priorities for early intervention and tackling health inequalities set out in the Scottish Government’s 2025 Population Health Framework and Service Renewal Framework.

The programme provides targeted funding to practices to implement activities under three themes:

• Community Connection – building inclusive patient engagement and participation.
• Enhancing workforce knowledge and skills – enhancing staff knowledge and skills on health inequalities.
• Proactive Outreach and Extended Consultations – enabling longer appointments and outreach for patients at greatest risk.

Methodology

The evaluation adopted a mixed-methods approach, combining:

• Surveys of staff and patients across participating practices.
• Qualitative interviews with staff and patients to explore experiences and perceived impacts.
• A Theory of Change workshop with stakeholders to test assumptions and refine the programme model.

This design provided robust evidence on implementation, outcomes, and sustainability.

Findings by Theme

Theme 1: Community Connection

Practices delivered a wide range of activities, including peer support groups, outreach events, and partnerships. These initiatives helped build trust and engagement, particularly among patients who face barriers to care. However, structured patient feedback to practices and collaborative working across practices or with third-sector partners were limited. Link workers played a vital role but faced capacity constraints.

Theme 2: Enhancing workforce knowledge and skills

Training in trauma-informed care, cultural competence, and communication skills was a success, improving staff confidence and morale. Practical tools, such as interpreter devices, supported implementation. Satisfaction and retention outcomes were positive, but the availability of dedicated learning time for IHAGP activity was not consistent, which needs to be addressed.

Theme 3: Outreach and Extended Consultations

Proactive outreach and longer appointments helped identify unmet needs and improve continuity of care. Patients reported feeling listened to and valued. However, definitions of “extended consultations” varied, and some practices implemented these in different ways (e.g. extending appointments for patients outwith the target groups). Limitations with coding practices and IT systems made it difficult to monitor these activities consistently.

Overall Reflections

IHAGP has delivered clear benefits: improved patient experience, enhanced workforce capability, and cultural shifts toward more inclusive care.

Staff reported increased confidence and morale, and patients described positive experiences of care.

Although there are some clear benefits from IHAGP, not all of these would be sustainable without continued funding. While many staff respondents (42%) report that aspects of IHAGP activity are now integrated into routine work, not all elements depend equally on continued funding. Some changes, such as redesigned DNA (Did Not Attend) letters for people who missed appointments, strengthened staff knowledge and confidence, adaptations to ways of working, and the development of new community links, are likely to endure because they have become part of everyday practice.

Other elements, particularly those that rely on additional time and capacity, are far more dependent on external support. Extended consultations, proactive outreach, and the dedicated time needed for staff to identify and engage harder‑to‑reach groups require ongoing funding, often to secure locum or backfill cover. This is reflected in the finding that 63% of staff believe their IHAGP activities would stop without continued investment. Dedicated time and continued funding are therefore essential to sustain the more resource‑intensive elements of the programme.

Implications for Theory of Change

The programme’s Theory of Change remains valid but requires refinement to:

• Emphasise IHAGP as a knowledge and capability building intervention.
• Focus on realistic, measurable outcomes.
• Clarify fidelity for key activities such as extended consultations.
• Embed patient feedback.
• Embed collaborative working between Multi-Disciplinary Team-(MDTs), patients, practices and communities.
• Make sustainability assumptions more explicit within the Theory of Change.

Conclusion

IHAGP has shown what is possible when practices are given the capacity and flexibility to innovate for inclusion. Although the programme has generated rich learning and delivered meaningful improvements within participating practices, its highly targeted scale and modest, annually allocated funding mean it is not designed, or resourced, to deliver system‑level change.

Rather, IHAGP offers valuable insights into approaches that can support more equitable, patient‑centred care in contexts of deprivation. Continued investment and a clearer focus on what the programme can realistically sustain will be vital to embed these approaches within participating practices and ensure that progress is not lost. The challenge moving forward is to use the learning generated by IHAGP to inform longer‑term, system‑wide efforts, while recognising that equitable access and patient‑centred care must ultimately be supported through broader structural investment.