Diving into the deep end: a scoping review on taking the plunge

Daniel Butler, Diarmuid O'Donovan, Jennifer Johnston, Nigel D Hart

General Practitioners working in deprived areas, where all-cause mortality rates are higher, face unique challenges. Despite 50 years passing since Tudor-Hart's seminal 'Inverse Care Law' paper, the health inequities gap is wide. 'Deep End GP' projects, are frontline General Practice led initiatives, working to close this gap, improving the health and lives of those most in need. To use scoping methodology to map out the process of creating a 'Deep End' GP group. A scoping review using Arksey and O'Malley's framework. MEDLINE, EMBASE, Web of Science and CINAHL databases, as well non-peer reviewed publications, were searched and articles extracted, reviewed and analysed according to iterative inclusion criteria. From an initial search number of 35 papers, sixteen papers were included in the final analysis. Key steps in starting a Deep End group are: quantifying patients and practices in areas of deprivation; establishing GP led objectives at an initial meeting; regular steering group meetings with close collaboration between academic and frontline General Practice, as well as the wider multi-disciplinary team; adopting a local Deep End Logo. Deep End GP groups have made advances to reduce health impacts of systemic health inequities. Starting a Deep End group involves a multidisciplinary approach, beginning with the identification of patients and Practices in areas of highest need. The findings and key themes identified in this scoping review will guide interested parties start the journey to do the same in their locality and to join the Deep End movement.