Socioeconomic inequality and barriers to primary care in Scotland: A literature review
This report presents a literature review on barriers to accessing primary care in Scotland. The report demonstrates that multiple factors tied to socioeconomic deprivation impact one’s ability to seek and reach healthcare, and experiences of care. It describes four areas of relevance to policy.
Conclusion and policy implications
The literature presented in this report, alongside discussion with the research advisory group and Scottish Government policy teams, has highlighted four considerations for ongoing programmes of primary care reform in Scotland. Some of these will require collaboration and engagement with policy makers and systems beyond healthcare. It is important to note that these considerations have been developed from the literature reviewed for this report, which largely focused on general practice settings.
- The report has identified several tangible barriers to engaging with primary care. These can relate to the messages conveyed by services, the systems in place for accessing appointments, as well as primary care settings and spaces. These system-related barriers are amenable to change.
- Improved understanding of the challenges related to socioeconomic deprivation may facilitate empathetic interactions with patients. Efforts to support the workforce in this regard should adopt an anti-racism lens.
- Establishing links between healthcare services, especially general practice, and the wider communities they serve, can facilitate patient empowerment and has the potential to enhance continuity of care.
- Inequalities in the accessibility of care and patient experience should be considered within programmes of primary care reform, informed by input from those most affected and their representatives.
Beyond the implications for primary care reform, the literature review has also highlighted considerations for future research in this area. Firstly, the literature search did not identify research focusing on barriers to accessing primary care on behalf of children or other dependents. This adds additional complexity and would warrant further research. Further, most of the research identified focuses on general practice. For example, literature referring to the inverse care law does not discuss other primary care services, limiting its relevance to the wider system.
Following the Short Life Working Group recommendation, the library database search focused on populations affected by socioeconomic inequality. The literature featured several different groups affected by material deprivation, but whose experiences of this, and of health and care, are diverse. To fully appreciate how these healthcare barriers may differ for these individual groups, more in-depth reviews could be commissioned in the future. Related to this point, assessments of socioeconomic deprivation were varied across the literature, and included the Scottish Index of Multiple Deprivation (SIMD) and employment. These measures are inevitably imperfect, for example assessments according to area may not account for the fact that those experiencing poverty can live in areas not designated as deprived[124]. It is important that researchers considering socioeconomic inequality are aware of the shortcomings of these measures.
More broadly, as reflected in this report, research on socioeconomic deprivation and healthcare access in Scotland often focuses on general practice. Academics associated with the ‘Deep End’ practices in Glasgow are particularly active in research on this topic. Going forward, it is important to build knowledge and understanding of access to primary care in socioeconomically deprived areas across Scotland, to ensure that policymakers and healthcare providers respond to the experiences and needs of people living with often hidden poverty and health inequalities in rural and remote areas or in less deprived urban settings.
This report is a contribution to ongoing programmes of work around health inequalities, a key priority for Scottish Government. Much of this will be brought together in the forthcoming Population Health Framework (2025), a cross-government and cross-sector approach to make progress on the Government’s four core priorities: eradicating child poverty, growing the economy, tackling the climate emergency, and improving Scotland’s public services[125]. The Population Health Framework will encompass actions which support all the Scottish Government’s four priorities, foregrounding a preventative approach. This will support growing the economy, eradicating poverty and supporting public services by improving the overall health of the Scottish population.