The department chose to axe a network of national support teams (NSTs) that helped PCTs and local authorities tackle issues such as teenage pregnancy, infant mortality and alcohol abuse.

The GPC reacted angrily, criticising the government for its ‘rhetoric’ over health inequalities.

Ministers have repeatedly stressed the need to tackle widening health gap between the richest and poorest to justify their public health reforms.

Only last month, public health minister Anne Milton MP (Conservative, Guildford) told a health select committee inquiry that the government ‘needs to address inequalities first and foremost'.

Yet the department chose to disband an operation that a recent DoH report admits was ‘not only effective, but valued and welcomed’.

Professor Chris Bentley, former head of the DoH’s health inequalities NST, tells GPonline.com he was very disappointed the work has been ‘chopped’.

NSTs worked alongside commissioners and local providers to form a picture of how various public health challenges could be better tackled.

As Professor Bentley explains: ‘We visited 80 of the most deprived areas [in England]. We’d go to each area for a week and start a review of what was going on, what was needed.’

Professor Bentley says the team dug out good practice and identified gaps where efforts could should focus.

It would then give advice – not diktat – for how the PCT or local authority could improve. The team made a further visit after six to nine months to see how the interventions had worked.

‘The health inequalities team wasn’t top down, telling people what to do,’ says Professor Bentley. ‘We were able to benchmark against other similar areas. But we’d report only to the local area.’

Asked why the DoH had withdrawn funding when it claims to prioritise health inequalities, a spokeswoman told GPonline.com the NSTs’ work focused on delivering against now cancelled national Public Service Agreement targets.

She said: ‘The targets have been abolished and the delivery model has changed with the focus now on shifting power to local level – to GPs and to patients themselves – in a patient-centred system, focused on outcomes.’

But Professor Bentley says the NSTs would have fitted well into the new government’s plans. ‘In terms of localism, it was actually a very good system,’ he says, adding it helped prevent ‘a lot of reinventing the wheel’ as the team could share ideas that worked between areas.

‘Valued’
The DoH report spells out the scheme’s successes.

It details how, ‘against the background of an increasing inequalities gap in the most deprived localities, localities which benefited from early visits by the health inequalities NST slowed down the mortality trend in males and closed their female average life expectancy gap between 2005/7 and 2006/8’.

In another case, one locality saved £100,000 by following NST advice over an advertising campaign.

Reactions at local level were overwhelmingly positive. The report found 92% of PCT and local authority senior leaders believed NSTs had improved the focus on an evidence-based approach to public health.

One PCT chief executive told the report: ‘We view the NSTs as an expert public health resource which we have drawn heavily on, helping us to see what is going well, what not so well and what we can do better.’

A director of public health working jointly between local authority and PCT level remarked: ‘In the future this sort of help will be even more important to focus on delivery of the new outcomes. We need to scrutinise at local level, share good practice from elsewhere and engage elected members much more.’

The report acknowledges that by the time they were scrapped in March 2011 the teams were ‘highly integrated into central thinking, a source of stability for local clients, the most visible concentration of national-level behaviour change expertise, and in a position to present a persuasive case as regards value for money’.

It concludes that NSTs had ‘clearly established an effective approach’.

Loss of support
But the decision to halt funding for the work means this support will no longer be available at a time when GPs, inexperienced at commissioning public health services, will take over budgets.

‘What our team did well was to demystify and bring it down to a practical level,’ says Professor Bentley. ‘The material accrued at DoH over five years was in a lot of ways related to what GPs were responsible for and could be doing.’

How well GPs commission public health services and combat health inequalities will directly affect GP income.

Under the government’s plans, GP commissioners will be required to reduce such inequalities in order to earn a ‘quality premium’ payment, which will contribute as much as £1 in seven of practice income.

GPs will be expected to commission effective public health services to cut inequalities in their local population. The loss of such valued work provided by the NSTs will surely make this task significantly harder.

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