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Lansley beefs up public health role for GPs

Public health white paper includes extra QOF incentives and training for GPs

Caroline White

Wednesday, 01 December 2010

GPs will be key players in the future of public health in England, under proposals set out in the white paper, Healthy Lives, Healthy People, published yesterday.

The plans specify the creation of Public Health England, which will take charge of the £4 billion ring-fenced public health budget and fund a wide range of services, from alcohol prevention to screening—and the transfer of directors of public health from the NHS to local authorities.

Public Health England will be responsible for the promotion of child health, including those services led by health visitors and school nurses, and some elements of the GP contract— including QOF—such as those relating to immunisation and contraception, plus dental public health.

It will encompass the activities currently carried out by the Health Protection Agency and the National Treatment Agency for Substance Misuse, both of which were culled in the arms length body review.

Although the new body will be directly responsible for the commissioning of some services and directing the yet to be appointed NHS Commissioning Board to commission others, there may be scope for GP consortia to commission on its behalf, says the white paper.

Under the proposals, the Department of Health will strengthen the public health role of GPs by encouraging GP consortia to take on board population health and reduce health inequalities. Information on access to services and public health outcomes will be made public in a bid to sharpen up practice achievements.

Changes will be made to the QOF to enhance preventive health. A sum “at least equivalent to 15% of the current value of the QOF” will be devoted to evidence based public health and primary prevention indicators from 2013.

Public Health England also intends to beef up public health education and training for GPs as part of the Department of Health’s development of workforce strategy.

One of the consultation questions accompanying the white paper’s publication asks whether there are any other ways in which GPs and GP practices can continue to play a key role in areas for which the new body will take on responsibility.

Other plans include:

  • A Public Health Responsibility Deal forged with business and the voluntary sector, on food, alcohol, physical activity, health at work and behaviour change—to be published next year
  • Creation of statutory health and wellbeing boards to strengthen local accountability
  • Creation of a new National Institute for Health Research (NIHR) School for Public Health Research and a Policy Research Unit on Behaviour and Health
  • Changes to the regulation of public health professionals

NHS Confederation acting chief executive Nigel Edwards backed the shift of public health to local authorities: “Councils can help people improve health in ways that the NHS cannot,” he said.

But he cautioned: “The relationship between GP consortia and local authorities is really crucial. GP consortia and local government need a shared plan for health social and public health so we can prevent the lack of co-ordination that has bedevilled this area in the past.”   

He suggested that it might be sensible to mandate that GPs sit on local council health and wellbeing boards or keep some public health expertise inside the NHS.  

But public sector union Unite rounded on what it called “ill thought out” proposals.

“How are local authorities, facing cuts of 28% over the next four years, meant to cope with this added massive layer of responsibility? They are already creaking at the seams,” said Unite’s National Officer for Health, Karen Reay. 

Dr Richard Jarvis, Chairman of the BMA’s Public Health Committee, said: “Public health doctors will be worried about some aspects of the government’s proposals. We are concerned that plans for local terms and conditions of employment may fragment the workforce.”


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