Intended for healthcare professionals


Getting back on track: control of covid-19 outbreaks in the community

BMJ 2020; 369 doi: (Published 25 June 2020) Cite this as: BMJ 2020;369:m2484

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  1. Peter Roderick, researcher1,
  2. Alison Macfarlane, professor2,
  3. Allyson M Pollock, professor1
  1. 1Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
  2. 2School of Health Sciences, City, University of London, London, UK
  1. Correspondence to: P Roderick peter.roderick{at}

Peter Roderick, Alison Macfarlane, and Allyson M Pollock argue there’s still time to change tack on the UK’s ad hoc system for covid-19 tracking, testing, and contact tracing

Historically, England’s system of communicable disease control has relied on close cooperation between local health services and authorities. General practitioners, NHS and public health laboratories, and local public health officers play key roles, backed by legal notification requirements.

That local system has gradually been eroded over several decades. (box 1) But instead of prioritising and rebuilding this system at the start of this epidemic, the government has created a separate system which steers patients away from GPs, avoids local authorities, and relies on commercial companies and laboratories to track, test, and contact trace. The ad hoc parallel system in England has three components:

Box 1

Erosion of local communicable disease control in England

At its height, local communicable disease control was supported by more than 60 national, regional, and local public health laboratories. The service was strengthened from 1977-2002 by the creation of the Communicable Disease Surveillance Centre in Colindale.

Erosion began after NHS reorganisation in 1974 and continued when the Public Health Laboratory Service Board was abolished in 2003 and its local laboratories transferred to NHS trusts, at the same time as communicable disease control was centralised in the Health Protection Agency.

In 2012, the Health and Social Care Act abolished locally based bodies in England and carved public health functions out of the NHS. Public Health England was set up as an executive agency to fulfil the government’s duty to protect the public from disease, with only nine laboratories and eight regional centres. Local authorities were charged with improving public health. Each local authority was required, acting jointly with the secretary of state, to appoint a director of public health, with responsibility for exercising the authority’s public health functions. …

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