Public health will suffer if GP commissioning groups are too small or the specialty is consigned to junior posts in local councils

BMJ 2010; 341 doi: (Published 11 October 2010) Cite this as: BMJ 2010;341:c5651
  1. Ann McGauran
  1. 1London

The United Kingdom’s leading professional body for public health specialists fears that the radical reforms outlined in the government’s NHS white paper could result in worse services.

The president of the Faculty of Public Health, Lindsey Davies, said that although the personal commitment of England’s health secretary, Andrew Lansley, to public health was “very encouraging, there are lots of ‘ifs’, ‘buts,’ and possible slips along the way.”

Introducing the faculty’s annual public health lecture and award ceremony in London on Wednesday 6 October, she said that the changes proposed in July’s Equity and Excellence: Liberating the NHS paper “could do a lot of good, but at the moment everything is very uncertain.”

The most important shift proposed in the white paper involves consortiums of general practices taking over responsibility from primary care trusts for commissioning health services. Other proposals include setting up a national public health service and an NHS commissioning board, along with local health and wellbeing boards.

Other proposed reforms include an NHS outcomes framework, the joint appointment of directors of public health with local authorities, a ringfenced public health budget, and a new health premium to promote action to reduce health inequalities. A public health white paper has been promised for December.

In its formal response to the NHS white paper last week, the faculty says that it is crucial that public health expertise should be “embedded in all aspects of health care, including commissioning groups and in providers.” A members’ survey on the white paper carried out in August found the public health workforce split between support and opposition to greater involvement of GPs in commissioning.

Ms Davies said it would be “brilliant if in a few years’ time we have GPs who are working with people who understand the local population and build that into their evidence,” and if academia, the government, and others were working together to improve the health of the population. “I am an optimist, and I do think there is a real chance we can get there. But there are real risks.”

She added, “If, for example, the definition of public health is too narrow or if GP commissioning groups are too small; if public health is not included in commissioning or if it becomes a relatively junior post in the local authority; or if our most experienced colleagues decide this is one reorganisation too far—any of this or all of this could result in a depletion or destruction of resources and services built up painstakingly over the last number of years.”

Ms Davies said that the faculty has a strong evidence base to draw on from its members’ survey. It received 1160 replies from its 3300 strong membership. Nearly half of those who responded (47%) thought that the changes and uncertainty would mean fewer trainees applying to work in the field. Members were virtually unanimous in the opinion that GPs would need input from public health specialists in commissioning.

Members who attended a workshop last week organised by the Department of Health team drawing up the public health white paper were vocal in their concerns. Sue Atkinson, a non-executive director at University College London Hospitals NHS Foundation Trust and former regional director of public health for London from 1999 to 2006, said, “There would be a very serious loss to the delivery of public health and whole population services if public health was not seriously involved in the quality and effectiveness of health services. Getting effective health services is going to be critically important if we are going to deliver.”

A legal hearing is set to start this week after the trade union Unison’s application for judicial review to the High Court. The union is challenging Mr Lansley’s refusal to consult the public on proposals in the white paper (BMJ 2010;341:c4716, 27 Aug, doi:10.1136/bmj.c4716).


Cite this as: BMJ 2010;341:c5651

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