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GPs urged to take 'proactive approach' to preventing ill-health

GP practices have ‘untapped potential’ and should take a more ‘proactive approach’ to improving the health of their patients, an NAPC-commissioned report says.

The report, carried out by the Nuffield Trust on behalf of the NAPC, said that GPs need to go beyond curing immediate illness and should proactively prevent ill-health.

It said interventions from the health services could help educate patients on the leading risk factors for illness and disability, which include hypertension, tobacco, alcohol misuse, high body mass index and low physical activity to prevent ill health.

GPs, with their registered lists of patients and neighbouring practices with whom collaborations could be organised, have ‘untapped potential’ to take a more active role in improving health and preventing illness, it said.

The report drew on current research, analysed routine data taken from a notional general practice of 10,000 patients to identify potential actions to improve community health and interviewed GPs and practice managers currently developing and testing new approaches to population health management with the NAPC.

The report said: ‘General practices, with its registered list of patients, has untapped potential to engage in a more proactive approach to improving the health and wellbeing of the local population. Such a focus is essential if the NHS is to meet the challenges of responding to the rising rates of chronic illness at all ages of the population, during a time of financial austerity.

‘There are already examples of GP-led practices engaging in work to improve access, outreach and management of both their chronically ill patients and those who are still healthy.’

Stroke and cardiovascular disease are top of the list of conditions underlying emergency admissions, and while many are appropriate, others may have been avoidable through better preventative care, it said.

It added that significant number of patients would not attend the practice once over the course of a year, therefore GPs will need to devise ways of reaching out to those registered but not regularly attending, in order to understand their lifestyle risks.

The report’s final recommendation was that the NHS should encourage CCGs to fund GP lead roles in population health, in order to create enthusiastic leaders who will articulate a vision of proactive general practice.

However, the report also found there were barriers to GPs taking on a more proactive role. It admitted that many GPs do not accept that population health is their responsibility, and they lack the training and skills to use public health data and techniques.

There are also fears the current reforms will distance the NHS from wider public health efforts coordinated by Public Health England, when public health professionals have not worked closely with general practice in the past. The report called on the DH to assess whether public health officials are building the required relationships with CCGs and GPs.

Another barrier is that the financial pressure on NHS England may result in CCGs focusing on meeting short-term goals resulting in quick financial wins (such as reducing elective or emergency admissions) rather than investing in preventative initiatives which can take years to change results, it said.

Ms Ruth Thorlby, Nuffield Trust Senior Research Fellow and author of the report said: ‘Many people have called for general practices to take a more proactive approach to population health in recent decades. We found that in this report for the NAPC that there is enthusiasm in general practice to make this vision real: at seems to be important is to allow local practices to define what this means for themselves, alongside identifying and supporting a cadre of GPs and other primary care staff to act as leaders

‘The immediate financial pressure on the NHS must not squeeze out investment in more prevention initiatives, which can often take several years to come to fruition.

‘In theory, NHS England and Monitor should enable flexibility in pricing and contractual systems, which could support innovation between general practice and other providers, and tilt the financial system away from the acute sector. However this means creating space for general practice to innovate as providers and not being inhibited by concerns about conflicts of interest.’

 

In a notional practice of 10,000 patients:

25% will be under 20 years old

16% will be 65 or over

1828 are likely to be current smokers

2,709 are overweight or obese

 

Over the course of a year:

25% will not visit the practice

12% will visit just once

47% will use secondary care at some point during the year

17% will use secondary care as an inpatient

 

The report analysed data from over 300 data sources to understand the ‘typical’ general practice.

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