Lindsey Davies: Q&A - Royal College of Physicians

More documents

Recommendations

Info

Feature In focus: public health Image©Shutterstock NHS reforms have shifted all eyes to the public health agenda and in particular health inequalities. Commentary asks three experts for their views – a public health doctor, a GP and a consultant. The full report is available online at www.rcplondon.ac.uk/commentary We live in a starkly unequal society. Our life expectancy at birth, our early development, educational attainment, chance of employment and chance of living in a favourable environment depend heavily on socio-economic status. Therefore, it is little surprise that differences in socio-economic status lead to inequalities in health. This has recently been elegantly described and demonstrated by Michael Marmott. This is not new knowledge. Douglas Black published his report on inequalities in health in 1980. In the 30 years since then inequalities in health and wealth have widened. We know that health inequalities are more dependent on relative poverty than absolute poverty, so they are not readily amenable to society’s preferred means of getting itself out of trouble – economic growth. Dr Richard Jarvis Consultant in health protection, Cheshire and Merseyside Health Protection Unit While it is refreshing to see mention of health inequalities as a driver of the government’s proposals for the NHS and a new public health system, it is difficult to know how the positive aspects will not be undermined by cuts made too hard, too fast, and in the wrong places. So what aspect of the proposals might help reduce inequalities in health The placement of directors of public health (DPHs) in local authorities should enable them to influence local decisions about adult social care, children’s services, education, environmental protection, transport and planning. All these have a bearing on inequalities even though this is not their prime focus. This potential will not be realised unless we can solve problems inherent in the Health Bill around how the DPH can act as a professional adviser to a political body; who, and with what qualifications, the local authority can appoint as their DPH; how the public health budget can be protected while simultaneously giving the DPH influence into other funding streams; and around variability of approach between local authorities. But what about ‘nudging’ and the idea that lifestyle problems are all amenable to individual choice In a perfect world where there is infallible information on which to base choice, where everyone has equal access to high-quality education, and physical and financial resources, this might be a reasonable assumption. But in today’s unequal society, choice, and therefore responsibility for health, is denied to those who most need to exercise it. Nudging is but one tool to use – we rely on it solely at our peril. n 14 Commentary n June 2011 n www.rcplondon.ac.uk
Feature Comment Write to us... Respond to any of the articles featured or share your views on RCP matters. Email us at: letters.commentary@rcplondon.ac.uk Around 70% of the UK population consults their GP every year, which is very important in terms of how much we can do to influence public health. GPs have a vital role to play in health promotion, disease prevention and in reducing health inequalities. Increasing attention is now paid to these topics in undergraduate curricula and in postgraduate training for general practice. There is also an increased awareness of the challenges of health inequalities and the provision of equable access to primary care services, as stressed by the Darzi report. Primary care teams can target the patients who need additional information about how best to use primary care services. We get to know our patients well, and develop an understanding of what action to take in different sectors and how to tailor health services for individuals. Professor Roger Davies Editor, British Journal of General Practice, emeritus professor of general practice, King’s College London, Royal College of General Practitioners There is evidence that the Quality and Outcomes Framework has reduced health inequalities, because it has encouraged GPs to focus on the whole practice population and to achieve targets for the majority of their patients. The proposed NHS reforms raise many challenges. One is to ensure that the National Outcomes Framework does not exacerbate health inequalities. This is something that the Royal College of General Practitioners is very concerned about. A move to private healthcare has the potential to worsen health inequalities because the more affluent and articulate members of society are likely to come off best. There are real opportunities for GP consortia to commission services in a way that is appropriate to the populations they serve. Working in partnership with public health and social care organisations, there would be nothing to prevent GP-led services from promoting health and reducing health inequalities. There are many examples of excellent group practice working, even in the inner city. At the Bromley by Bow Centre in the east end of London, for example, a wide range of care is integrated on one site, with mental health patients running a café and elderly Bengali men training in IT alongside a large group practice. This is a particularly inspiring example, but if this can be achieved at one practice then it should be possible elsewhere. If GPs are to be given a major role in commissioning in the future, they will need to work closely with colleagues in public health and secondary care, as well as the welfare and social care sectors, to assess needs and deliver effective services. n I believe that all doctors should have an eye on the public health agenda. Specialty-based training for physicians should not drive neglect of responsibilities for prevention, but fuel a wider responsibility for improving population health. If there was one aspect of training I would change it would be to ensure exposure to public health for all specialty trainees and exposure to an ‘ology’ for all public health trainees. The NHS needs to treat populations and individuals so that both arenas work well together. The major restructuring of the NHS risks a loss of much of the corporate memory and many of the relationships that have been built to enable the NHS to play its part in addressing social determinants of health and inequalities. There is a risk that moving public health into local authorities will challenge the ability of individual clinicians to influence public health, unless bridges into health service delivery organisations (and to clinicians) are retained. Therefore, it is imperative that as clinicians, we take a keen interest in the reforms. On a positive note, a stronger link with social care and across other government agencies will, if public health directors and clinicians are able to influence it, allow us to prioritise the social determinants of health agenda. Clinicians need to contribute to partnerships working across public health, primary care and secondary care to promote public health and address health inequalities. We may now be able to have stronger access into social care and local government to really impact on social determinants of health. The structures Image©Shutterstock that have traditionally Dr Kiran Patel Consultant cardiologist and honorary senior lecturer, Sandwell and West Birmingham NHS Trust, and clinical director (QIPP), NHS West Midlands Strategic Health Authority allowed cross-sector and interorganisational working are in a state of flux, so we must ensure bridges are built to maintain existing partnerships and to link to other partnerships. The fragmentation of providers creates the risk that competition might trump collaboration for large-scale service developments. Clinicians must challenge areas of reform that risk widening inequalities. As providers we are advocates for our patients, but as commissioners GPs are advocates for their patients and their populations. Provider clinicians must work with GPs to ensure that we deliver services to address inequalities and improve the health of all. Smoking cessation is as important as angioplasty of the coronary arteries and we must not forget that. It is not one or the other, but both which will improve health outcomes. n www.rcplondon.ac.uk n June 2011 n Commentary 15
Page 1 and 2: Interviews Features News Events Jun
Page 3 and 4: Contents Commentary Membership maga
Page 5 and 6: News Comment Write to us... Respond
Page 7 and 8: News The HIU 10 years on Tasked wit
Page 9 and 10: News EU rules on alcohol labelling
Page 11 and 12: Lindsey Davies: Q&A Comment Write t
Page 13: Lindsey Davies: Q&A Comment Write t
Page 17 and 18: Feature Comment Write to us... Resp
Page 19 and 20: London 2012 Olympics Comment Write
Page 21 and 22: London 2012 Olympics Comment Write
Page 23 and 24: Regulars Comment Write to us... Res
Page 25 and 26: Regulars Comment Write to us... Res
Page 27 and 28: Events diary Teach-in programme 201
Page 29 and 30: Education MSc in Medical Leadership
Page 31 and 32: Supporting physicians through educa

Lindsey Davies: Q&A - Royal College of Physicians

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?