Reclaiming a population health perspective

This research report explores the role general practices can play in improving population health at a time of increasing levels of chronic ill health and reduced budgets.


Published: 25/04/2013

ISBN: 978-1-905030-64-4

Download the report [PDF 291.8KB]

The report, which was written by the Nuffield Trust, commissioned by the National Association of Primary Care (NAPC), examines the arguments for encouraging and enabling general practices to take a much more proactive role in improving the health and wellbeing of their local populations, as well as their individual patients.

It also draws on analysis of routine data from a notional general practice of 10,000 patients and a series of interviews conducted with GPs and practice managers who are participating in the NAPC’s newly-established Practice Innovation Network, which brings together staff from GP practices to develop and test out new approaches to population health management.

Much more could be done to reach out to their local communities and prevent chronic conditions, at the same time as taking better care of those with long-term conditionsRuth Thorlby, Nuffield Trust Senior Fellow and report author

The report is authored by Ruth Thorlby, Senior Fellow at the Nuffield Trust. Several key points are made in the report, including:

  • general practice, with its registered list of patients, has untapped potential to engage in a more proactive approach to improving the health and wellbeing of the local population;
  • interviews with GPs, practice managers and other staff reveal both an appetite for improvement in access, outreach and management of chronically ill patients, and a multitude of ideas about how this might be realised;
  • the recent NHS reforms present opportunities for a more proactive approach to prevention and population health. But sustained progress will depend on alliances with other practices, local communities, clinical commissioning groups, local authorities, local academic groups and the full range of community partners and providers;
  • successful projects will depend on imaginative approaches to deploying staff and good-quality data and risk stratification tools.

Ruth Thorlby, the report’s author, said:

’There was real enthusiasm for change amongst staff from these general practices, who feel that much more could be done to reach out to their local communities and prevent chronic conditions, at the same time as taking better care of those with long-term conditions.

‘Achieving this vision will require support, to help practices make better use of their staff and data, and form strong working partnerships with other practices and providers.’

This research forms part of the Nuffield Trust’s programme of work that aims to support the development of new models of primary care, alongside the emerging clinical commissioning groups.



Suggested citation

Thorlby R (2013) Reclaiming a population health perspective. Research report. Nuffield Trust.