Although GPs are ideally placed to lead the fight against the UK’s growing public health crisis, it will be no easy task, warns CMO Professor Dame Sally Davies.
England’s first female CMO says that general practices, at the heart of local communities, can lead the ‘prevention agenda’ that the NHS desperately needs.
‘We’re finding it very difficult as a society to take personal responsibility, whether it’s for obesity, alcohol or drugs,’ says Dame Sally.
‘Behavioural change, to take the responsibility to protect ourselves and do the right thing, is very difficult.
‘This is where GPs can play a larger part, drawing attention to these problems, giving advice and making suggestions. GPs build relationships with patients – particularly with families – so they’re listened to.’
The UK faces many health challenges – people are getting fatter, antimicrobial resistance threatens to render many treatments useless, and problems such as mental illness and liver disease are on the increase.
With all this on her plate, it’s no surprise that our meeting at the DH’s Richmond House headquarters in Whitehall comes at the end of a hectic day for Dame Sally.
She has been in meetings with DH public health officials all day – ‘the most inspiring group of people’ – but the government’s top medical adviser is keen to talk about the challenges the NHS faces.
Antimicrobial resistance is recognised as a threat worldwide and now features on the UK’s national risk register – a list of potential threats to national security. Dame Sally highlighted these concerns in her annual report on infection last March.
‘Resistance is a natural phenomenon,’ she says. ‘What drives it is taking antibiotics when you don’t need them. We misuse antibiotics in the community and in hospitals.’
She concedes that some GPs may be too liberal in handing them out. But, she adds: ‘GPs are pressured to prescribe antibiotics, and don’t have the lab test there quickly to tell them if they’ve prescribed the right one.’
Dame Sally points to the RCGP TARGET toolkit as good practice, and advocates prescribing antibiotics, but directing patients not to take them unless symptoms worsen.
She hit the headlines recently after expressing concern that society was ‘normalising’ being overweight.
‘What I highlighted in the annual report was that normal weight is now overweight and a high proportion of people don’t recognise they’re overweight. In one study, 77% of parents of overweight children didn’t recognise their children were overweight – how do you deal with it if you don’t know?’
Dame Sally says it is important to have open discussions in the community about what ‘normal weight’ is. She warns that GPs should not be afraid to talk to patients about their weight as an essential part of primary care – even in consultations about unrelated problems.
‘It absolutely is a GP’s duty to let patients know if they or their children are overweight, because it is the precursor of such dreadful ill health.We can’t afford to ignore it.’
This leads her to a more controversial point – that GPs should strive to set an example to patients, maintaining a healthy weight themselves.
‘It is difficult for GPs and nurses and everyone in the community, but how are they to have the impact on patients if they are not thinking about it for themselves?’
This is just part of the larger preventive role that Dame Sally believes GPs should have.
For example, a slew of preventable conditions are to blame for rising UK levels of liver disease related deaths, a trend the CMO finds ‘disturbing’.
‘Serious liver disease is, in the main, preventable. It’s alcohol, obesity and viral infections like hepatitis.
‘GPs have an advice role and it’s a very difficult role. With obesity, it’s weighing, with alcohol, it’s asking about intake, and if they think someone is misusing drugs, explaining about safe use.
‘We need to do something about it. But I don’t expect GPs to be able to wave a magic wand and make everything better.’
GPs can play a greater part in mental healthcare, too, she believes. GPs need strong basic mental health training and should be supported with CPD, she says, admitting: ‘I don’t think we have given many GPs that sort of education.’
The switch to four-year GP training should come ‘sooner rather than later’, she says, with ‘at least four, if not six months’ focusing on mental health. Paediatrics and dermatology training are another priority.
GPs are well placed to address the public health crisis, but many will feel the growing general practice crisis is the greatest impediment they face. Until rising workload is dealt with, the profession may struggle to respond to Dame Sally’s call to arms.