How primary care providers can rise to the challenges of the public health agenda

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 savings it is easy for commissioners and providers to focus on short-term savings rather than the longer term savings that can be unlocked by tackling the public health agenda.

In addition to losing sight of the numerous benefits that a proactively managed public health agenda can provide for patients over the course of their lives, ensuring parity and equity in the access to the best possible clinical outcomes.

For decades the potential for general practice to have a positive impact on chronic ill health has been recognised. Now, with three quarters of the NHS’s budget resting with clinical commissioning groups and the general practices they represent, general practice has never been in such an influential position to impact on the long-term health of their practice populations.

This Nuffield Trust research report is not a systemic review of what has gone before, but instead looks to the future and how primary care providers can innovate in ways that will allow them to rise to the challenges of their registered populations.

A 2011 King’s Fund review concluded that: ‘general practice is regarded as uniquely well placed not just to provide medical care, but also to promote the health and wellbeing of the practice population and to address health inequalities. However, there has been little success in drawing GPs ‘beyond the surgery door’ and GPs still concentrate on what are essentially clinical activities.

‘Generally, GPs focus their prevention-related actions on patients at high risk rather than taking a whole population approach or maximising opportunities for health promotion advice to all patients who might benefit.’

As a result of general practice beginning its journey as the key driver in the new NHS landscape we hope that this work will aid clinical commissioning groups and general practice to capitalise on the current innovative work being undertaken by the NAPC’s Practice Innovation Network.

We hope to inspire providers of primary care to think differently with regards to how they view their own practice populations and distil what key chronic health indicators are most prevalent within their population, and how they can best approach these health inequalities.

In the report: Reclaiming a population health perspective, we talk of taking a ‘population health approach’. In essence this approach can be defined as including the following characteristics:

• an interest in the health and wellbeing of local populations or communities;

• in addition to (but not instead of) a focus on individuals and family care by primary care providers;

• proactive, preventative care for both healthy and chronically ill people;

• a focus on the distribution of health within populations;

• proactive care for people attending regularly who are at risk of deteriorating health; and

• thinking about the health of people who are registered but not attending regularly.

We hope that this important piece of work helps general practice and other primary care providers to start to think about how to approach these crucial issues, and to think about how they can begin to contribute to the longer term health needs of their registered populations and the wider public health agenda.

The NAPC’s Practice Innovation Network is open to all primary care providers and hosts a national networking hub for the discussion and dissemination of innovation.

The NAPC would welcome and encourage contributions from primary care providers that would like to comment on, or contribute to the debate that this report examines.

Dr Nav Chana is Vice-Chairman of the National Association of Primary Care. Please note that the views expressed in guest blogs on the Nuffield Trust website are the authors’ own.

This blog was also posted on GPonline's Inside Commissioning blog.