COMMENT
What skills will GP commissioners require from public health practitioners and vice versa under the future NHS? Jenny Wright, executive director at Solutions for Public Health, explains.
U
nder the auspices of the NHS Alliance, QIPP Right Care Team,
and Solutions for Public Health, GPs and senior public health practitioners came together to debate what skills and exper- tise GP commissioners would need in the future from public health colleagues and how they might access them.
The summit, in January 2011, was intend- ed to start to fill an acknowledged policy gap in the current proposals.
During the 1990s, in a world of GP fund- holding and total purchasing pilots, GPs and public health practitioners recognised the complementarity of their respective contributions for effective purchasing of healthcare. The GPs’ understanding of the individual patient and family’s needs in the local community context, married with the whole population approach adopted by their public health colleagues, maximised health benefits in terms of both clinical need and the cost effectiveness of service delivery.
During the 2000s, agenda changes under the New Labour government led public health practitioners more down the path of developing effective partnerships with local authority colleagues to tackle the broader determinants of health, such as people’s environment and housing, social exclusion and deprivation. Meanwhile, GPs, in some parts, sought to reap benefits from marginal changes to primary care services by engaging in practice-based commissioning.
The Coalition Government, with its policy move to hand the bulk of commissioning over to GP consortia, has reawakened in- terest in the public health/primary care axis. This interest is focused on public health expertise, based on health needs as- sessments of whole populations. Looking at the evidence of what works and target- ing services based on this evidence can work to ensure maximum health gain and a reduction in inequalities.
But it is all within a different public health system than the one we have now.
The January summit confirmed that the agenda was very much alive for public health colleagues to work closely with GP commissioners, practices and primary care. GPs were clear that they would need skilled help to work on effective interven- tions, including behaviour change, to un- derstand and model where commissioning could have the greatest impact on reducing health inequalities, and use evidence and intelligence to remodel pathways to de- liver QIPP agendas.
The problem came in ascertaining how to access these skills – who would be avail- able to them, where would they be based, would the services come at a price and could new consortia afford them?
In considering this, GPs were faced with, potentially, three public health systems to navigate: the health improvement system provided through local government in fu- ture, the health protection system provid- ed through the new centralised structure of Public Health England, and the system to support health services commissioning, as yet undecided.
The GPs could see clear ways in which they will need to interface with the upper tier of local government (unitary authorities and county councils) where the Director of Public Health and support will sit in future, as well as an agenda over which they will need to work together and over which they will need public health skills to deliver; Joint Strategic Needs Assessment and joint commissioning.
They were less clear over how they will in-
terface with the new health protection sys- tem at the local level. This would involve local health protection units and environ- mental health departments within unitary authorities and lower tier district councils for outbreak management, immunisation support and infection control, and emer- gency planning. They have had relatively little engagement with the current system, and were very unclear over their precise role in the new system.
And the future relationship between the health protection units and the Director of Public Health appeared vague.
Lastly, whilst they recognise an absolute need for technical public health skills sup- port for health services commissioning, how and where these will be accessed in future is completely unclear. It seems un- likely that consortia, particularly small ones, will be able to afford to employ di- rectly these skills.
At the moment, the remit for support to health services commissioning is not within the sphere of either Public Health England or the proposed role of the Director of Public Health.
There is a willingness to work together to provide effective structures, interfaces and support for the future. But there is also a relatively short window of opportunity, whilst GP consortia are being established, to provide clarity over future arrange- ments.
GP commissioners urgently need help and guidance in find- ing their way through the three mazes of what will comprise the public health sys- tem in the future.
Jenny Wright
FOR MORE INFORMATION The full report from the Colloquium event, published in February 2011, is available to download at
www.sph.nhs.uk/colloquium
E:
solutions@sph.nhs.uk W:
www.sph.nhs.uk
national health executive Mar/Apr 11 | 23
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