Changing the conversation about health

How to fix public health? A new breed of GP is needed…

College of Medicine founder, senior GP and NHS England social prescribing champion, Dr Michael Dixon, told this week that public health needs to be ‘built around general practice’, with an increased role for volunteers.

Here, Dr Luke Allen, GP Academic Clinical Fellow at the University of Oxford adds his voice to the debate:

The burden of disease is changing in a way that makes the current GP model obsolete.

Sitting in a room and waiting for sick people to present with problems is the very definition of shutting the door after the horse has bolted.

As more that half of all death and disease is now caused by modifiable environments, social structures, and behavioural risk factors, the main responsibility of health workers is shifting from managing disease to prevention.

Of course not all conditions are preventable, and GPs and allied primary care workers will always be required for their invaluable face-to-face (physical or virtual) patient-centred, holistic, longitudinal service. It’s just that this activity is no longer sufficient to meet the aims of keeping populations healthy and the NHS operational.

Working at the level of populations to address social structures in order to improve health is the definition of public health.

Dr Luke Allen

Recurrent cuts have severely constricted the ability of local public health teams to effectively assess and address social determinants down at the level of neighbourhoods and communities – where the social determinants manifest (schools, kebab shops, bike lanes, parks, housing estates, dangerous roads, road pollution etc).

Fortunately, near-enough every community in Britain is served by a health team who see the social drivers of disease at work in their patients every single day.

GPs and public health teams have a shared responsibility for the health of communities and should be working much more closely.

I don’t want GPs to expedite the erosion of public health in the UK, but primary care teams should be assessing and proactively addressing social determinants that drive disease in their listed populations.

Just as ‘primary care classic’ will always be needed, it is important to stress that public health consultants are irreplacable. Properly funding public health should be a stratigic priority for
the NHS. But even if public health was running at full-throttle there would still be an important role for GPs to play in promoting health and preventing illness on the streets.

GPs are working at maximum capacity just to stay afloat, so adding new responsibilities sounds absolutely perverse. However, when you zoom out to take the longer view, failure to adopt population-level prevention is masochistic.

The initial investment would improve outcomes, reduce costs, and help to reduce demand for appointments.

There are a few dedicated mavericks leading this change, but it will not become routine until the system realigns.

Training, workforce, time, money, governance, accountability, and incentives are focused on individual-level consultations. The reactive/curative paradigm has to go.

The sustainability of the NHS is dependent on system-level change from NHSE and CCGs, and a new breed of GP.

To read’s article featuring Dr Michael Dixon, click here