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GPs have ‘untapped potential’ to improve public health

Appetite for change in general practice but GPs face many challenges

Louise Prime

Thursday, 25 April 2013

GPs and their primary care colleagues have the opportunity to take a more proactive approach to improving public health following the changes to the NHS in England, the Nuffield Trust said this morning. The authors of its latest report Reclaiming a population health perspective, produced for the National Association of Primary Care, claim that GPs have “untapped potential” to engage in a more proactive approach to improving their community’s health and wellbeing – but only if they are empowered to do so.

They write that while the NHS is facing considerable financial challenges, it is essential to focus attention on combating the rising rates of chronic illness at all ages of the population.

Among GPs and practice managers whom they interviewed, the report’s authors found an appetite for change as well as many ideas for new approaches to population health management. They argue that this – in combination with existing financial incentives for screening, immunisation and better management of specific conditions – means general practice is well set up to “play a powerful proactive role in community health”.

However, they say, GPs may be distanced from efforts to improve the local population’s health since the NHS reforms in England transferred responsibility for public health away from the NHS and to local authorities.

They say the Department of Health should ensure that public health professionals work closely with GPs and clinical commissioning groups (CCGs), “building relationships and adding capacity and expertise so that general practices are able to access and use data and evidence”.

The Nuffield Trust acknowledges that there are challenges to realising the full benefits of a primary care-led approach to population health. For example, there was a feeling among some GPs that public health is not their responsibility, and some were not well enough trained or skilled to use public health data and techniques. The researchers argue that collaboration between smaller practices would help, and that clinical commissioning groups would be “an obvious source” of data tools.

In addition, GPs very often complained in the interviews about the growing workload in general practice. The report’s authors suggest finding ways of working within general practice that make better use of existing staff, and taking an imaginative approach to skill mix.

Report author Ruth Thorlby, senior research fellow at the Nuffield Trust, said: “Many people have called for general practices to take a more proactive approach to population health in recent decades. We found … that there is enthusiasm in general practice to make this vision real: what seems to be important is to allow local practices to define what this means for themselves, alongside identifying and supporting a cadre of GPs and other primary care staff to act as leaders.

“The immediate financial pressure on the NHS must not squeeze out investment in more prevention initiatives, which can often take several years to come to fruition.

“In theory, NHS England and Monitor should enable flexibility in pricing and contractual systems, which could support innovation between general practice and other providers, and tilt the financial system away from the acute sector. However this means creating space for general practice to innovate as providers and not being inhibited by concerns about conflicts of interest.”

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