THE so called inverse care law is three decades old. It describes a paradox whereby the heaviest users of the NHS are those in least need of health care.

It is a recognised problem that access to health care and the distribution of resources do not always match need.

The GPs at the Deep End project was designed to help put the issue on the agenda and find ways to reverse the effect. By creating a loose organisation of practices in Scotland working in the 100 most deprived areas of the country, Glasgow GPs were able to highlight some of the problems – for example practices in areas where a high proportion of patients have multiple chronic conditions receiving the same resources as those in leafy suburbs with lists of predominantly healthy, well off patients.

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The initiative had an impact and Deep End GPs now receive extra funding to help tackle health inequalities. It wasn’t ever a solution, but it seemed a sensible response to a long-standing dilemma.

So it is alarming to find that some of this additional resource has gone not on health initiatives but on boosting the income of doctors in those same practices.

Research by public health consultant Dr Helene Irvine appears to show that, in the NHS Greater Glasgow and Clyde (NHSGGC) area, family doctors earning the highest incomes are concentrated in those areas with the highest level of social deprivation. In one case a doctor in a Deep End practice was earning in excess of £300,000, more than three times the national average.

Dr Irvine believes there are wide variations, with some GPs working in poor communities earning relatively modest salaries and others maximising their incomes to quite abnormal levels. Unfortunately it is impossible to delve into the detail of these findings as Dr Irvine’s employers NHSGGC have not published her research. Neither have the Scottish Government or the British Medical Association, both of whom are privy to the study.

This lack of transparency is quite unjustifiable and throws into perspective a general lack of clarity about how doctors are paid.

By long-standing practice, NHS GPs are employed as independent contractors. It is a model which generally serves the public well, allowing doctors to run their surgeries according to their own judgement, taking into account local needs and priorities, and without excessive bureaucracy. But the lack of any openness about what GPs earn is a weakness in the system.

Dr Irvine says there is no logical explanation for the correlation between GPs with high incomes and areas with high deprivation. Were her findings to be published, perhaps an answer would emerge. Or perhaps it would be clear that some family doctors are taking the system - and the taxpayer for a ride.

Either way, publication would enable a proper discussion to take place about GP remuneration, and those who pay themselves more could come forward to justify that choice to politicians and the public.

The Scottish Government admits there is significant variation in GP pay around Scotland, and hopes the new GP contract will help address the issue. The BMA also believes discussions around the new contract could clarify anomalies in GP income.

But primary care expert professor Philip Wilson, of Aberdeen University argues doctors incomes should be published, as they are, for example, in Norway and now in England.

There may very well be a case for that. But as a first step, in the interests of transparency and accountability to the taxpayer, he Scottish Government should insist NHSGGC puts Dr Irvine’s findings in the public domain – or heed the suggestion of Dr Richard Simpson and instruct Audit Scotland to investigate.