NHS funding crunch creates a challenge for GPs to improve public health

The recent reforms to the English NHS present opportunities for GPs and other primary care staff to lead a more proactive approach to prevention and helping people remain healthy into old age but only if they are empowered to do so, argues a new report written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC).

Reclaiming a population health perspective says that GPs have untapped the potential to engage in a more proactive approach to improving the health and wellbeing of the local population. Such a focus is essential if the NHS is to meet the challenges of responding to rising rates of chronic illness at all ages of the population, during a time of financial austerity.

But it warns that the current NHS reforms, which have resulted in responsibility for public health being transferred from the NHS to local authorities, may risk distancing GPs in particular from efforts to improve the health of their local communities.

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 Ruth Thorlby, Nuffield Trust Senior Fellow and report author

The report concludes it will be important for the Department of Health to assess whether public health professionals are working closely with GP communities and clinical commissioning groups, building relationships and adding capacity and expertise so that general practices are able to access and use data and evidence.

The report analyses routine data taken from a notional general practice of 10,000 patients to identify potential actions to improve community health. It also draws on a series of interviews with GPs and practice managers currently developing and testing new approaches to population health management with the NAPC.

The interviews reveal both an appetite for further change and a range of ideas about how such approaches might be realised. Together these sources point to a number of factors that set general practice up well to play a powerful proactive role in community health.

The report also charts the recent reforms to primary care which provide an encouraging basis on which to deliver more proactive services.

Financial incentives for screening, immunisations and better management of specific conditions have for example already led to an increasing emphasis on prevention and to the infrastructure required to deliver these.

Ruth Thorlby, Nuffield Trust Senior Fellow and author of the report said:

‘Many people have called for general practices to take a more proactive approach to population health in recent decades.

‘We found that in this report for the NAPC that there is enthusiasm in general practice to make this vision real. What seems to be important is allowing 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.’

The challenges that policy-makers may need to consider addressing to realise the full benefits of a primary care-led approach to population health include:

• Many GPs not accepting that population health is their responsibility and a relative lack of training and skills to use public health data and techniques.

  There is now a range of risk tools to identify high-risk patients. Smaller practices, for instance those with fewer than 2,000 patients, may need to collaborate in order to get access to data tools (or indeed provide preventative services to local communities). An obvious source is clinical commissioning groups, which are expected to demonstrate a detailed understanding of population needs as part of their authorisation process.

• Capacity and resource limitations facing many general practices.

  A very commonly expressed concern from interviewees was the growing workload in general practice. A priority, therefore, is to identify ways of working within general practice to make better use of existing staff, and explore using different kinds of staff in different ways. A more proactive approach is likely to imply an imaginative approach to skill mix within general practice, including a willingness to use other professionals such as staff with different backgrounds, for example as health trainers.

Dr Nav Chana, Vice-Chairman of the National Association of Primary Care added:

‘This important report highlights the huge potential that primary care can make to delivering ‘state of the art’ population based health care. The practices participating in NAPC’s innovation network, and whom this report is based, have espoused the values of population health care, which underpin NAPC’s ambitions for the health service.’