Just over a decade ago a special meeting of GPs was held in Glasgow to discuss the challenges facing primary care.

What was different about this gathering was they all worked in practices serving the most deprived areas of Scotland.

It was the first time in the history of the NHS such a group had been convened.

Ten years on, the Scottish Deep End GP project has grown into a movement with the model being picked up elsewhere in the UK including Yorkshire and Humber, Great Manchester and Plymouth, and internationally in Ireland and Australia.

Dr Anne Mullin, a GP in Govan, was among those who attended the initial meeting in September 2009.

“It was really the first time any of us got together as a group of GPs that served deprived communities,” she said.

“For a lot of people it was the first time you could hear viewpoints and discuss common issues – there had been no forum for that, so it was really important.”

At the heart of the project, Mullin says, are theories such as the inverse care law of Julian Tudor Hart - those who require health services the most often find them hardest to access.

Also key is the concept of ‘proportionate universalism’, put forward by Professor Sir Michael Marmot, which suggests resources should be used to benefit everyone’s health, but especially poor and marginalised groups.

Beyond the theories and principles, it takes only the briefest glimpse of at data which shows Scotland’s stark health inequalities gap to understand what lies at the core of the Deep End project.

However, Dr Mullin says the experience of ‘Deep End communities’ is more complex than the headlines would suggest – pointing out Govan, for example, has lots of green space and a mixed community including teachers, students and asylum seekers.

“Deprivation is one of these terms which is chucked out there a bit like poor communities - and what does a poor community look like?” she said.

“Poor communities have great thriving community projects and lots of support and tolerance, they are welcoming and inclusive.”

When the Deep End initiative was set up, the focus was on ranking GP practices according to the proportion of registered patients living in the most deprived 15% of Scottish postcode zones.

The top 100 which make up the Deep End practices have at least half of their patients in this category.  

However, Dr Andrea Williamson, a GP who works in Glasgow, said there would now be a shift to ‘Deep End patients’.

“Although Deep End practices are really important, most people who experience severe socio-economic impoverishment are in so-called pockets of deprivation – so actually looked after by practises which aren’t within the Deep End.

“So moving forward into the next ten years we want to focus a lot more on the Deep End patient – wherever they are.”

It’s often a challenge to scale up small initiatives, but one of the most successful ideas pioneered by the project was link workers, which connect patients to suitable community resources to help improve their health and wellbeing.

The Scottish Government recently pledged to roll out 250 community link workers in GP surgeries by 2021.

Being able to give a voice to patients experiencing the impact of austerity over the past decade has also been vital for the Deep End GPs.

Dr Williamson said: “One of things that has been very key for us is that the voices of patients and socio-economically deprived communities are not always listened to as much as they should be.

“Basically we got really angry when austerity started to kick in and the whole welfare reform agenda began.

“We said this is not working, this is not helping our patients and provided evidence to various committees at Westminster and Scottish Parliament to say that.

“That has been part of the wider social movement which says austerity is not working for people.”