Public health

General practice seems to be considered by politicians and the media as both the cause of and solution to the current crisis in demand for urgent and emergency care.

At the same time, the primary care community is recognising that the current business model of general practice is under threat due to increased demand by patients, growing regulatory workload and, for some this year, significantly less income.

From discussions with GPs and policy makers, there appears to be some consensus that the current ‘small scale’...

The release today of a crucial report written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC) sets out the challenges that face primary care and general practice.

In particular, the report looks at moving from a purely curative and reactive based approach to patient care, to one that is balanced against making significant inroads into the reduction of the rise in chronic ill health set against the backdrop of an ageing population.

As the NHS struggles to meet unprecedented financial efficiency...

Our new series of interactive charts: The NHS in numbers pulls together some key data on health care spending, activity, resources and performance. These charts broadly cover the boom years for health care in the UK, from the late 1990s to the early 2010s, reflecting the latest data publicly available from official sources.

During this period, when Government spending on the NHS rose at the fastest rate experienced throughout its history, both public and private spending on health care increased year-...

There is nothing like the New Year for compiling a 'to do' list, and nothing more satisfying than to start the list with some things you already have under way, so that you can tick a few off immediately. Last week the coalition Government gave us their version in the form of the Mid-Term Review.

The NHS chapter pulls together a series of previously announced service initiatives (e.g. rolling out telehealth and telecare, implementing a 'friends and family test'); details of their performance meeting targets and initiatives put...

The Nuffield Trust’s new NHS reform timeline is a salutary reminder that the NHS, and health services internationally, teem with ‘wicked problems’.

A phrase originally used in social planning, this describes problems difficult or impossible to solve because of incomplete, contradictory, and changing requirements, often hard to define. Sometimes those seeking to solve the problems are also causing them. Often one wicked problem is merely a symptom of another one.

Solutions to wicked problems are better or worse, not right...

Is it possible to have strong general practice (GP) ownership of a primary health care organisation, whilst pursuing a population health agenda? Geoff Meads termed this age-old tension between general practice and public health the attempt to mix oil and water.

In mineral-rich but water-poor Australia recently, I had a strong sense of déjà-vu about the general practice-public health tension.

Australia is setting up a national network of 'Medicare Locals' as part of wider health reforms. These new organisations will be responsible for planning more integrated, local primary and...

The joys of policy analysis mean the NHS Operating Framework is obligatory reading. 'Grip' is its message, no surprises there. But tucked in amongst the pages four things caught my eye.

Para 3.29 requires commissioners to link patient NHS numbers to contractual payments by March 2013. By then, it should be possible to identify routinely how much NHS expenditure goes on each individual – a crucial milestone to identify efficiencies. My bet is on information to give the NHS the biggest lift over the coming decade.

The second was para 4.24 – in response to...

The Government’s reform of public health services (detailed in the White Paper: Healthy lives, healthy people: our strategy for public health in England) has reignited debate about the importance and future of public health in the English NHS.  Although admittedly that discussion has sometimes been drowned out by the sound and fury provoked by the wider structural reform programme.

The key argument for retaining public health involvement in the new system...

An interesting thing occurred when Andrew Lansley announced that NICE would no longer recommend which drugs and treatments should and should not be offered on the NHS – NICE became, well nice.

The alternative, new local commissioners having to make these decisions at a local level looked inequitable and unworkable.  After all, NICE has been a lightening conductor for public anxiety around rationing, and has taken difficult and highly technical decisions out of the hands of local commissioners.

Following a recommendation from the...

Finally there is more detail on how public health will be delivered in the future. The Government’s response to its consultation on the Public Health White Paper: 'Healthy Lives, Healthy People', goes some way to addressing the key gaps that we and others have identified around commissioning, but other issues are still far from resolved.

Right now public health specialists work closely with commissioners to conduct needs assessments and evaluate service outcomes.  They...

I was in Lisbon last week to speak at a chronic disease workshop run by the National School of Public Health.  Both the English and the Portuguese health services currently face a significant funding squeeze, and policymakers in the two countries see chronic diseases as an area ripe for potential cost savings.  However, in Portugal the focus is on different chronic diseases from those on which we concentrate in this country. Moreover, the emphasis in Portugal is on reducing the expected costs of these chronic diseases, whereas in the UK we tend to focus on preventing the...