Addressing the inverse training law: developing, sustaining and expanding GP training in socioeconomically disadvantaged neighbourhoods: A Qualitative Study

Abstract Background Training in socioeconomically disadvantaged neighbourhoods offers unique educational opportunities for developing competence in navigating complexity, cultural diversity, and health inequalities. The Deep End (DE) Network supports general practices serving the most socioeconomically disadvantaged communities. Despite greater population need, the inverse training law means that registrars have fewer opportunities to learn in these settings. Previous evaluation of the TrainDEEP (TRaining Assistance INitiative in DEep End Practices) intervention demonstrated that investment in trainer development and protected time could successfully establish new GP training practices within DE communities. The intervention has evolved to support training continuity and growth within established training practices. This study aimed to explore how training capacity can be developed, sustained, and expanded in DE settings, while examining the learning experiences and professional development of those involved in training and delivering care in these contexts. Methods A qualitative thematic analysis of semi-structured interviews with professionals across 8 DE practices in the North East and North Cumbria, England. Participants included GP trainers, intending trainers, registrars, GPs and practice managers. Results 23 interviews were conducted between January-May 2026. Four key themes were identified. (1) Learning in the Deep End described how exposure to clinical complexity, cultural diversity, and health inequalities enhanced learning, while also presenting emotional and professional challenges. (2) Developing and sustaining educational capacity highlighted the importance of protected time, trainer development, succession planning, and organisational support. (3) Preparing and supporting learners in disadvantaged settings identified gaps in training related to health inequalities, consultation skills, and complex biopsychosocial care, alongside a need for enhanced peer support. (4) Influence on professional identity and career intentions demonstrated how DE placements increased confidence in working with underserved populations and, for some trainees, influenced future career choices. Conclusions DE practices provide rich educational environments that support experiential learning, professional identity formation, and the development of competencies needed to care for populations experiencing socioeconomic disadvantage. Sustaining and expanding training in these settings requires investment in trainer development, succession planning, educational infrastructure, and learner support. Interventions such as TrainDEEP may help address the inverse training law while strengthening both workforce sustainability and health-equity-focused GP education.