GP leaders in Scotland have called on the Scottish Government to significantly increase the share of NHS funding going into general practice as a new report highlights the pressures facing doctors working with patients from the most deprived areas.

The report by the Royal College of General Practitioners (RCGP) in Scotland says that general practice must be allocated "at least 11%" of the NHS budget in order to tackle the growing burden of disease coming from an ageing and growing population, particularly in the poorest areas.

At the moment, general practice is estimated to receive around a 6-8% share of health spending, down from around 10% 20 years ago.

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The report also calls for a review of funding streams to ensure that investment and extra workforce resources can be "channelled" into practices based in the areas of greatest deprivation.

It says that the current GP Workload Formula, which calculates how much funding each practice gets based on appointment numbers as a measure of demand, is "unlikely to fully account for the most deprived, and certainly does not account for increased complexity of consultations, nor unmet need".

The formula has faced repeated criticism for disadvantaging rural practices and Deep End GPs - those working in the 100 most deprived areas of Scotland - because the type of work they do is less likely to translate into a high volume of 10-minute appointments per day compared to practices in more affluent areas with high numbers of very elderly patients.

The report adds that while the Scottish GP contract agreed in 2018 was intended to improve health inequalities "there is an emerging view that the new contract primary care arrangements are actually widening them".

GP practices in the most deprived areas - where patients are most in need - "have lower staffing levels", despite people living in these communities having twice the prevalence of multi-morbidity by their early 50s compared to the least deprived areas.

Despite much higher levels of need and premature mortality, funding levels per registered patient tend to be lower in the most deprived, than least deprived, areas.

Premature mortality (dying before 75) and comorbidities increase in line with deprivation, but this is not reflected in funding levels per patient (Image: RCGP, 'The Scottish GP Workforce and Socioeconomic Health Inequalities') Avoidable mortality rates are more than three times higher for males in the most deprived, compared to least deprived, areas (Image: RCGP, 'The Scottish GP Workforce and Socioeconomic Health Inequalities') The report, entitled 'The Scottish GP Workforce and Socioeconomic Health Inequalities', also warns that GPs working in these practices experience higher levels of burnout and job satisfaction compared to colleagues in more affluent areas.

It follows on from the RCGP Scotland's GP Voice Survey, the 2024 annual survey of GP members, which found that 83% of GPs are concerned about the impact of poverty on their patients' health. 

It also found that 71% of respondents have seen a year-on-year increase during 2024 in the number of presentations to general practice that could be linked to, or worsened by, poverty.

A fifth (22%) reported a significant increase in those presentations, and zero respondents reporting a decrease.

The RCGP report praises a scheme, announced in April 2023 by then-First Minister Humza Yousaf, which allocated an additional £1 million of funding to the 81 'Deep End' GP practices located within NHS Greater Glasgow and Clyde, but stresses that "we want to see the expansion of initiatives like this".

RCGP Scotland said it would also like to see medical students and GPs-in-training get more exposure to what it's like providing care in the most deprived areas (Image: PA)RCGP Scotland chair, Dr Chris Provan, said: "The Scottish Government has a clear understanding of health inequalities, but its persistent implementation gap means we have not yet seen the progress we need.

"The evidence shows that a robust primary care service with general practice at its heart is the lynchpin to delivering better health outcomes and a more equitable Scotland.

"That is why we are calling for the Scottish Government to commit to increasing general practice funding and workforce, with a review of additional resource to be allocated in line with proportionate universalism principles.

"We know that GP practices in deprived areas are understaffed and subject to multiple inverse care laws, which negatively impacts morale and wellbeing and subsequently risks retention and therefore high quality and timely patient care."

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Dr Provan said the "cycle" of deprivation, disease, and health inequalities would continue without action, adding that medical students and GPs in training need "more exposure and opportunity in practices serving deprived communities" to help boost recruitment. 

He added: "That means inclusion health from the beginning of medical education, addressing the participation and attainment gap of medical students, and offering fellowships and training programmes."

A Scottish Government spokesman said: “We are investing £3 billion a year on measures to tackle inequalities, poverty, and the cost of living crisis which can lead to health inequalities.

“We have significantly expanded the primary care multi-disciplinary team workforce, with over 4,900 staff working across key services, including Community Link Workers, as at March 2024.

"And we are working to increase the number of GPs in Scotland by 800, by 2027.

“Through our Child Poverty Practice Accelerator Fund we are supporting innovative local projects to tackle child poverty.

"This includes projects to help families access health services and to increase advice on financial inclusion in health settings."