The NHS reforms in England 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, experts warn.GPs have untapped the potential to engage in a more proactive approach to improving the health and wellbeing of local populations, and 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, says a new report from health policy think tank the Nuffield Trust.
But 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, warns the report, which was commissioned by the National Association of Primary Care (NAPC).
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 (CCGs), building relationships and adding capacity and expertise so that general practices are able to access and use data and evidence, it says.
Interviews - conducted with GPs and practice managers who are currently developing and testing new approaches to population health management within the NAPC - reveal both an appetite for further change and a range of ideas about how such approaches might be realised, says the study. "Together, these sources point to a number of factors that set general practice up well to play a powerful proactive role in community health," it notes.It also charts the recent primary care reforms, and says these provide an encouraging basis on which to deliver more proactive services. For example, financial incentives for screening, immunisations and better management of specific conditions have already led to an increasing emphasis on prevention, and to the infrastructure required to deliver these services.
In recent decades, many people have called for general practice to take a more proactive approach to population health, and the report has found enthusiasm within general practice to make this vision real, said study author Ruth Thorlby, a senior fellow at the Nuffield Trust.
"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," she comments.
Ms Thorlby also emphasises that 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 [regulator] 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," she says.
The study also points to challenges that policymakers may need to consider addressing, in order to realise the full benefits of a primary care-led approach to population health, including:
- 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. While there is a range of risk tools to identify high-risk patients, smaller practices (such as 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 CCGs, which are expected to demonstrate a detailed understanding of population needs as part of their authorisation process; and
- capacity and resource limitations facing many general practices. A very commonly-expressed concern during the report interviews 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 use other professionals such as staff with different backgrounds, for example as health trainers, it says.