Are the Health of the Nation's targets attainable? Postal survey of general practitioners' viewsBMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7089.1250 (Published 26 April 1997) Cite this as: BMJ 1997;314:1250
- Philip Cheung, directora,
- A Pali S Hungin, directorc,
- Jo Verrill, research associatea,
- Andrew J Russell, lecturerb,
- Helen Smith, directord
- a Centre for Health Studies, University of Durham, Durham DH1 3JT
- b Department of Anthropology, University of Durham
- c Northern Primary Care Research Network, The Health Centre, Eaglescliffe, Stockton on Tees
- d Wessex Primary Care Research Network, Aldermoor Health Centre, Southampton
- Correspondence to: Dr Cheung
- Accepted 14 April 1997
The Health of the Nation's targets were introduced by the government in 1992 as part of a strategic approach to health.1 We aimed, in 1996, to elicit the views of general practitioners on the attainability of these targets.
Method and results
We sent a piloted and validated questionnaire using ranking lists, Likert scales, and open questions to 390 general practitioners: 196 in the Northern region (98 (50%) were members of the Northern Primary Care Research Network) and 194 in Wessex (94 (48%) were members of the Wessex Research Network). The overall response rate was 66% (n=257): 70% (138/196) from the Northern region (network members 77% (75/98), non-members 64% (63/98)); and 61% (119/194) from Wessex (network members 76% (71/94), non-members 48% (48/100)). The response rate was thus higher for network members. The respondents' age, sex, and fundholding status reflected the overall situation in England.2
Most of the respondents considered the targets to be unattainable (table 1). The targets for cancer were ranked as the relatively most attainable nationally and the reduction of suicide rates the least attainable. Likert responses confirmed the ranking results, with cancer again regarded as most attainable, followed by HIV infection and AIDS, accidents, coronary heart disease and stroke, and mental illness.
For their own practices respondents ranked coronary heart disease and stroke as the priority target, followed by cancer, mental illness, accidents, and HIV infection and AIDS. Of the respondents, 159 (58%) agreed that their practice should have a strategy for working to meet the Health of the Nation's targets; 137 (50%) respondents reported having such a target in the following categories: coronary heart disease and stroke; cancer; mental illness; HIV infection and AIDS; and accidents (table 1).
Obstacles to pursuing the targets at practice level were: excessive workload in the primary healthcare team, targets too ambitious, time scales unrealistic, apathy among patients, and lack of funds. Comments also centred on the lack of influence of the primary care team over socioeconomic factors linked to ill health; difficulty in persuading the public to change established habits and lifestyles; the lack of centrally controlled media campaigns and of political will towards smoking; and low morale. More practice nurses, health visitors, and health education specialists were needed with emphasis on health education for interventions already proved to be effective. Help was also needed with further team training, information technology, and better accommodation.
Despite a climate of questionnaire fatigue3 the response rate was high, with many respondents clearly eager to make their views known, as indicated by the strength of feeling in the comments. The overwhelming view that the targets were unlikely to be achieved reflected the recent House of Commons inquiry.4 It was unclear why respondents were relatively more optimistic about targets for cervical and skin cancer, although this may be linked to existing campaigns and public awareness, factors largely outside the control of the practice team.
Despite a lack of belief in the attainability of the targets, half of the respondents had practice based strategies for meeting them. Some clear messages emerged about these: an over ambitious time scale, a lack of resources, and the inability to influence the root of the disease locally. Additionally, there is uncertainty about the effect of continuing morbidity trends and the effectiveness of national health campaigns.
Effecting mass change in behaviour that is a risk to health and influencing factors such as personal motivation and socioeconomic conditions are beyond the remit of the primary healthcare team and possibly even beyond national campaigns. This study confirmed a wide gap between nationally set targets and belief in their success, pointing to a need for a better understanding of the role of general practice for focusing policy and activity.
We thank Dr Mark Williamson, general practitioner, Marske Medical Centre; Mrs Kate Hewitt, administrative secretary, Northern Primary Care Research Network; and Mrs Vivien Flowerday, secretary, Centre for Health Studies, University of Durham.
Funding: No special funding.
Conflict of interest: None.