Inclusion Health Action in General Practice (IHAGP): evaluation

Introduction

Health inequalities remain one of the most persistent challenges in Scotland, disproportionately affecting people living in socioeconomically deprived communities. These inequalities manifest in poorer health outcomes, reduced life expectancy, and barriers to accessing timely and appropriate care. ^{[2] [3]} General practice, as the cornerstone of primary care, is uniquely positioned to address these disparities through inclusive, proactive, and patient-centred approaches.

Recognising this, the Scottish Government introduced the Inclusion Health Action in General Practice (IHAGP) programme in 2023 as part of its wider Care and Wellbeing Portfolio. This chapter sets out the policy context for IHAGP and outlines the remit of, and levels of participation in, the programme. It also explains the purpose of this evaluation and summarises the programme’s underlying Theory of Change.

Policy Context

The IHAGP programme was conceived as a targeted intervention to enhance healthcare delivery to patients experiencing, or at high risk of, health inequalities.

It was developed following recommendations from the Short Life Working Group on Health Inequalities in Primary Care (2022), which highlighted the need for targeted resources to support practices serving the most disadvantaged populations. IHAGP aligns with national priorities in the Scottish Government’s 2025 Service Renewal Framework and Population Health Framework, both of which look to redouble efforts to tackle health and healthcare inequalities in Scotland with a clear focus on early intervention and prevention.

Programme Remit and Participation

Highly targeted in nature, the programme currently provides funding to 66 individual general practices within NHS Greater Glasgow and Clyde, where the majority of Scotland’s “Deep End” practices – in areas of high deprivation – are located.^[4]

IHAGP provides funding for practices to implement activities under three themes:

1. Community Connection – building inclusive patient engagement and participation.

2. Enhancing workforce knowledge and skills– enhancing staff knowledge and skills relevant to health inequalities.

3. Proactive Outreach and Extended Consultations – enabling longer appointments and outreach for patients at high risk of ill health due to poverty and inequality.

Each theme contributes to reducing health inequalities, with an emphasis on accessibility, inclusivity, equity and addressing barriers to accessing healthcare.

Participating practices have ‘opted in’ to the programme and been given broad discretion in using IHAGP funding to finance activities under the different themes and meet local population needs.

£300,000 was allocated for 2022/23 and up to £1,000,000 per year available in financial years 2023/24, 2024/25 and 2025/26. Allocations to practices are based on patient list size and the proportion of their list living in an area of high disadvantage using the Scottish Index of Multiple Deprivation (SIMD).

Purpose of the Evaluation

The Scottish Government commissioned this second-stage evaluation to build on an early assessment conducted in 2023/24^[5]. That initial evaluation focused on process questions and staff perspectives, providing valuable insights into implementation but leaving gaps in understanding—particularly around patient experiences and the impact of proactive outreach and extended consultations.

This evaluation seeks to:

• Assess how IHAGP interventions have changed service delivery, with emphasis on extended consultations and outreach.
• Capture patient perspectives on these changes, including experiences of access, engagement, and perceived impact.
• Identify barriers and enablers to implementation and explore sustainability and scalability.
• Inform future policy and funding decisions, ensuring lessons learned contribute to embedding health equity approaches across primary care.

Theories of Change

IHAGP is guided by a nested theory of change, which articulates how programme activities are expected to lead to improved health equity. The overarching theory assumes that providing targeted resources to practices in deprived areas will enable them to implement inclusive and proactive interventions, which in turn will:

• Increase patient engagement and trust.
• Improve access to care for those facing the greatest barriers.
• Enhance workforce capability to deliver trauma-informed and equity-focused care.
• Reduce unmet health needs and improve health outcomes over time.

Each theme has its own sub-theory:

• Community Connection: Building relationships and participation will strengthen trust and empower patients to engage with services.
• Enhancing workforce knowledge and skills: Training and knowledge-sharing will improve staff confidence and sensitivity, leading to more equitable care.
• Proactive Outreach and Extended Consultations: Longer appointments and outreach will allow clinicians to address complex needs holistically, reducing missed opportunities and improving continuity of care.

These pathways are underpinned by assumptions and existing evidence contained within the theories of change about capacity, understanding of how funding can be deployed and collaboration with community resources. The evaluation tests these assumptions and examines whether the intended causal links are being realised in practice.

Summary

IHAGP represents a strategic effort to tackle health and healthcare inequalities through targeted investment in general practice. By focusing on inclusion, proactive care and workforce development, the programme aims to create sustainable changes – as well as more immediate impacts that may or may not be sustainable – which contribute to improvements in access and outcomes for those most at risk of poor health outcomes due to socio-economic deprivation and disadvantages. This evaluation provides evidence on the effectiveness of these interventions and the validity of the programme’s theory of change, informing decisions about the future of IHAGP and its role within Scotland’s health equity agenda.