Lindsey Davies: Q&A - Royal College of Physicians

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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