Public health should be rebuilt around general practice, says top GP

Public health needs to be 'built around general practice', with an increased role for volunteers, a senior GP and NHS England social prescribing champion has said.

Dr Michael Dixon
Dr Michael Dixon

Devon GP Dr Michael Dixon told GPonline that in its current form, public health was simply 'not working', and had become disconnected from front-line clinicians.

'Public health is not working in the way we are currently configuring it,' he said, 'because if you look at the rates of stress and depression, of diabetes and obesity or even of cancer and long-term disease generally, they are still rising.'

Responsiblity for public health shifted to local authorities from the NHS as part of health service reforms that took effect in 2013. GPonline reported earlier this year that three quarters of GP partners had seen cuts to public health-related enhanced services over the past year.

Front-line GPs 

Dr Dixon, a former chair of the NHS Alliance, added: 'The problem with public health is that we have handed it to consultants - people who aren’t working at the front line of medicine. I think this is inappropriate as it’s only at the very front line - in communities and in consultations - that we’re really going to make the difference that’s required.

‘Public health is really the responsibility of all of us - clinicians and patients - and it should not have been simply devolved to public health consultants. Yes, great plans are made, reports produced, but the actual engine room of change when it comes to health I think needs to be far closer to the front line. That’s why I think, personally, that it should be built around general practice.’

As part of the shift in responsibility of Dr Dixon said GPs increase links with volunteers within their local community and empower patients to look after their own health through social prescribing.

‘In my practice, for instance, patients run a lot of the activities like the walk and talk exercise, like the integrated library, like health advice and we’ve even got retired social workers, primary school teachers and health visitors who run a child and adolescent mental health service. So what we’ve done is actually get volunteers together to provide, if you like, a first line of help. This is the ethos we need to engender within the whole service.’

Social prescribing

A survey by GPonline last year showed that social prescribing is already used regularly by around one in five GPs, and earlier this year the RCGP said that the introduction of dedicated social prescribing staff within practices could ease pressure on GPs and cut workload.

‘It does require some pump-priming, but not a great deal,' Dr Dixon said. ‘We’ve got a social prescribing facilitator who is currently paid out of private funds, but she’s training up four or five volunteer prescribers. So for a relatively small amount - roughly the cost of two hip operations - we could in our community of 20,000 patients do an immense amount in terms of mobilising the local population to look after their own health.

‘But these are ideas that have to be funded, they have to be incentivised. This is something that general practice is well capable of doing, and it has an enormous potential, but it just needs the recognition on on high to be given support.’

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