Re: Future shape of general practice in England
We were surprised that Gillam in discussing the future of general practice did not mention public health.(1) We believe that general practice has key roles to play in promoting health both at an individual and community level. There are many opportunities for promoting health in this setting but for many topics for effectiveness it is important that there is action in other settings as well, including: schools; workplaces; and hospitals. In relation to some of these settings there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention.(2)
There are three criteria for creating health promoting settings: create a healthy work environment; integrate health promotion into activities; and, establish links with the community.(2) It has been known for a long time that the workplace can have a powerful effect on the health of individuals, both physical and psychological. Moreover guides are available for making the workplace more conducive to health.(3) However some would suggest that many general practices and hospitals are far from healthy places to work in.
NHS England’s Five Year Forward View proposes that we need a radical upgrade in prevention and public health and that they will support “comprehensive and hard-hitting” action to tackle priorities such as obesity, diabetes and inequalities.(4) One initiative is to provide incentives to encourage the NHS to be a healthier workplace. The document also highlights that primary care is central to targeted prevention, but at the same time admits that primary care has been under-resourced.
There is growing evidence that funding in general practice is lower than current needs: a shortfall of over 3000 GPs has been estimated.(5-8) Moreover, and critical for population health is the finding that under-doctored areas tend to be those with the greatest health needs.(5) With workforce shortages like these it should not be surprising to hear reports from general practice of stress and burn out.
Crucial to the future development of health promoting general practices and hospitals is government support, both in terms of enabling public health professionals to be facilitators of positive change and by providing different types of resources. For example, health promoting initiatives for staff will have little effect if they are undermined by a lack of staff to undertake the fundamental tasks.
1) Gillam S. Future shape of general practice in England. BMJ 2014;349:g6268 (21 October)
2) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
3) Faculty of Public Health and the Faculty of Occupational Medicine. Creating a healthy workplace: A guide for occupational safety and health professionals and employers. London: Faculty of Public Health, 2006
4) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. October 2014. www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.
5) Goddard M, Gravelle H, Hole A, Marini G. Where did all the GPs go? Increasing supply and geographical equity in England and Scotland. Journal of Health Services Research & Policy. 2010. 15(1): 28–35.
6) Centre for Workforce Intelligence. In-depth review of the general practitioner workforce. 2014. www.cfwi.org.uk/publications/in-depth-review-of-the-gp-workforce.
7) NHS GP Taskforce. Securing the future GP workforce—delivering the mandate on GP expansion. 2014. http://hee.nhs.uk/wp-content/uploads/sites/321/2014/07/GP-Taskforce-repo....
8) Limb M. Increase GP trainees by 450 a year to avoid crisis, says taskforce. BMJ2014;349:g4799.
Competing interests: No competing interests