Tackling the crisis in general practice

BMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i942 (Published 17 February 2016) Cite this as: BMJ 2016;352:i942

Re: Tackling the crisis in general practice

We agree with many of the points made by Roland and Everington in their editorial on the crisis in general practice, but do think they have missed one of the elephants in the room: public health.(1) Urgent action is needed in key areas including smoking, obesity, and mental health. In addition, and related to all of these, is the ubiquitous problem of inequalities.(2,3) We believe that there is a growing consensus that public health action is needed to improve health and wellbeing, tackle inequalities, and relieve some of the burden on our overloaded NHS.(4,5,6)

Potentially, general practice has key roles to play in promoting health both at an individual and community level.(7) However, a recent scoping study found evidence that GPs often feel ill equipped to give prevention and health promotion advice to patients.(8) Furthermore, in relation to effectiveness, for many topics it is important that there is action in other settings as well, including workplaces; schools; and local communities. Public health departments should be coordinating and facilitating such activities and providing training for a wide range of professionals including doctors and nurses.

Although in the past there has been a dearth of information about the effectiveness of health promotion in the primary care setting, health promotion theory provides a number of frameworks that should be used to guide action.(7,9) Also, there are a growing number of reviews that highlight opportunities, especially in public health priority areas.(e.g. 10-13)

It is clear to us that funding in general practice is lower than current needs: a shortfall of over 3000 GPs has been estimated.(14-18) In addition, and critical for population health, is the geographical inequity in the provision of GPs. The workforce is unevenly spread across the country, with the fewest doctors in the areas of greatest need.(19) This has the potential to exacerbate health inequalities.

We are in no doubt that general practice has the potential to play crucial roles in maintaining and improving the health of local populations. However, doctors and nurses must be given the tools to undertake the tasks. Fundamental to this is having adequate capacity and sufficient resources; these are essential in relation to developing high quality health outcomes. The Government must re-order its priorities towards prevention and health promotion: funds must be found to tackle this crisis in general practice.

1) Roland M and Everington S. Tackling the crisis in general practice. BMJ 2016;352:i942.

2) Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380:37–43

3) Charlton J, Rudisill C, Bhattarai N, et al. Impact of deprivation on occurrence, outcomes and health care costs of people with multiple morbidity. J Health Serv Res Policy 2013;18:215–23

4) Wanless D. Securing our future health: taking a long-term view. Final report. 2002. http: //si.easp.es/derechosciudadania/wp-content/uploads/2009/10/4.Informe-Wanless.pdf.

5) Marmot M. Fair society, healthy lives: strategic review of health inequalities in England post-2010. 2010. www.instituteofhealthequity.org/projects/fair-society-healthy-lives-them....

6) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. 2014. www.england.nhs.uk/wp-content/uploads/2014/10/5yfv-web.pdf.

7) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

8) Peckham S, Falconer J, Gillam S, Hann A, Kendall S, Nanchahal K, et al. The organisation and delivery of health improvement in general practice and primary care: a scoping study. Health Serv Deliv Res 2015;3(29).

9) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001

10) BMA. Alcohol misuse: tackling the UK epidemic. London: BMA, 2008.

11) Academy of Medical Royal Colleges. Measuring Up: The Medical Profession’s Prescription for the Nations Obesity Crisis. London: Academy of Medical Royal Colleges 2013.

12) BMA. Promoting a tobacco-free society. London: BMA, 2015.

13) Watson M C and Errington G. Preventing unintentional injuries in children: successful approaches. Paediatrics and Child Health. 2016. http://dx.doi.org/10.1016/j.paed.2015.12.006

14) 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.

15) 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.

16) 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....

17) Limb M. Increase GP trainees by 450 a year to avoid crisis, says taskforce. BMJ2014;349:g4799.

18) Royal College of General Practitioners. Seven day access to routine general practice – position paper. London: RCGP, 2015

19) Baker M, Ware J, Morgan K. Time to put patients first by investing in general practice. Br J Gen Pract 2014;64:268–9.

Competing interests: No competing interests

22 February 2016
Michael Craig Watson
Associate Professor of Public Health.
Dr Mark Forshaw (President, Institute of Health Promotion and Education. Subject Leader in Psychology, Natural Sciences and Psychology, Liverpool John Moores University.)
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA
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