GP services in England get multibillion cash injection in landmark deal

BMJ 2016; 353 doi: (Published 21 April 2016) Cite this as: BMJ 2016;353:i2297

Re: GP services in England get multibillion cash injection in landmark deal

In recent years there has been a developing consensus that public health action is needed to improve health and wellbeing of our communities and relieve some of the burden on our overloaded NHS.(1-3) NHS England’s Five Year Forward View for example, proposed that we needed “a radical upgrade in prevention and public health” and that they would support comprehensive and hard-hitting action to tackle priorities such as obesity, diabetes and health inequalities.(3) So although we welcome the considerable steps to strengthen and support general practice that were announced in General Practice Forward View we were surprised that so little was mentioned about public health.(4)

General practice has for a long time been the "sleeping giant" of public health, its huge potential to promote the health of individuals and communities has never truly been tapped.(5-8) Around 90 per cent of patient interaction in the NHS is with primary care services. Registration with a GP provides an important link with an individual that can last many years, including those where significant health events occur. There are, therefore, many opportunities for promoting the health of individuals and their families. Moreover, in terms of reach, there are millions of consultations between patients and GPs every year: potential does exist.

Besides knowledge about individuals, many doctors have a good knowledge of their local community including information about local factors that may influence health. This presents opportunities for practices to play more roles in tackling certain public health issues. In addition, GPs are accorded a high status and credibility - so they have the potential to act at an individual and community level on public health matters.

It is important to highlight that practices include a wide range of staff who can contribute to promoting the health of communities. Besides GPs, primary care teams may include nurses and administrative support, pharmacists, paramedics, social workers and others. In the past public health staff have been involved in training teams so that they would have the knowledge and skills to provide coordinated public health action.(9) The amount of support available will be significant factor in determining the level and quality of public health activities in general practice.

It should not be forgotten that general practice is also a workplace where a substantial number of people work. The workplace can have a powerful effect on the health of employees, and a number of authors have written about the benefits of creating a healthy workplace.(10-11) This setting provides access to a target group that is to a certain extent a ‘captive audience’. Therefore, long-term effective interventions can be planned to support staff. Although General Practice Forward View does mention that support will be provided for GPs suffering from burnout and stress, we think that far more is required; health promoting workplaces should be created. This would have benefits for doctors, nurses and other practice staff and would also have an impact on patient health. In addition, if a practice were to create a healthy working environment, it could be used as a model to encourage other workplaces to follow.

For some time it has been well recognised that general practice has been substantially underfunded and critical for population health is the finding that under-doctored areas tended to be those with the greatest health needs.(12-14) General Practice Forward View does take steps to address some funding and support issues - but further support will be necessary in relation to public health. The time has come to awaken this “sleeping giant” in order to enable healthy communities to develop: health promoting general practices are needed.(6,7)


1) Wanless D. Securing our future health: taking a long-term view. Final report. 2002. http: //

2) Marmot M. Fair society, healthy lives: strategic review of health inequalities in England post-2010. 2010.

3) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. 2014.

4) NHS England. General practice forward view.

5) Faculty of Public Health Medicine. Strategies for Health Promotion in Primary Health Care. London: Faculty of Public Health Medicine, 1993.

6) Baric L. Health Promotion and Health Education in Practice. Module 2. The organisational model. Altrincham: Barns Publications, 1994.

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) Health Education Authority. Primary Health Care Team Workshop Manual. A Guide to Planning and Managing Workshops for Primary Health Care Teams. London: HEA, 1991.

10) 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.

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

12) 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.

13) NHS GP Taskforce. Securing the future GP workforce—delivering the mandate on GP expansion. 2014.

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

Competing interests: No competing interests

25 April 2016
Michael Craig Watson
Associate Professor of Public Health.
Professor Sylvia Tilford (President elect, Institute of Health Promotion and Education, Welwyn AL6 0UD, UK.
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA
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