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Contract at odds with patient need

GPs will find out in March how the Government expects them to expand their role in public health, but experts warn of the dangers of spreading GPs' time too thinly ­ Rob Finch reports

The Government expects GPs to play as big a role in tackling obesity as they have in smoking cessation,

under plans laid out in its White

Paper on Public Health.

Nationwide rollout of exercise referrals and prescribing of pedometers are set to form part of the Government's delivery plan due in March.

Speaking exclusively to Pulse last week, deputy chief medical officer Dr Fiona Adshead said the delivery plan was 'one of a raft of commitments' aimed at transforming the health of the nation. She said she was keen to see successes in areas such as smoking cessation translated to other areas of public health ­ particularly obesity.

Independent policy and public health experts are warning the Government's 'bizarre initiatives' may have little tangible benefit for public health.

But Dr Adshead, a former public health consultant who played a key role in developing the White Paper, remained bullish and enthusiastic about its potential benefits. She told Pulse: 'All doctors have a dual role in promoting health and treating disease. Some of the most visionary people in public health have been GPs. Primary care has already contributed a lot.'

She said GPs had successfully delivered on initiatives such as smoking cessation and would be keen to deliver a 'broader range of services'.

She added: 'We're producing our delivery plan in February or March as part of a raft of commitments in the White Paper. We need to think what GPs are doing around exercise schemes and using pedometers. PCTs in many parts of the country are already thinking about how to develop care pathways.'

The Government has piloted a series of health promotion schemes that look set to form a central platform of the delivery plan.

In Dorset, high-risk patients were identified through GP registers and referred to a six-month weight reduction programme. Nearly a third of patients achieved the target 5kg weight loss (see box 1).

A second pilot offered GPs across 135 PCTs the chance to prescribe

pedometers to encourage exercise among overweight patients (box 2).

And GPs in the Wirral carried out a 10-week pilot in which fruit and vegetables were prescribed to patients at high risk of CHD (box 3).

Dr Adshead said: 'What will happen is already happening around the country. It's about spreading best practice but also about what services we want to deliver.'

But the Government's ambitious approach to transforming the role of the GP carries risks as well as potential benefits, public health experts have warned.

Professor Rod Griffiths, a former GP and now president of the Royal College of Physicians faculty of public health, said the Government's delivery plan needed to focus on what was achievable. 'The biggest risk is dissipating GPs' energy over too many objectives. There are clearly workforce issues,' he said.

'Evidence is there in the White Paper though some of the suggestions have more behind them than others.'

He argued there were several areas needing clearer thinking: 'There are a number of pilots of health trainers, but they have all piloted something slightly different. We need to work out some of the competencies, training needs and how we deploy them.'

Professor Allyson Pollock, chair of health policy and health services research at University College London, was more vocal in her reservations.

'Increasingly GPs are chasing targets in public health ­ most of which are guff. Yet there's all this pressure on PCTs to meet these targets. You might get a plethora of bizarre initiatives [as a result of the White Paper], but you'll get less of what you actually need. No amount of "fat camps" will do any good if you have private finance initiatives that close the playing fields.'

Dr Chaand Nagpaul, GPC representative on the BMA's public health committee and a GP in Stanmore, Middlesex, said: 'Like many Government initiatives they are strong on vision but scant on detail.

'The Government needs to be very mindful of the current pressures on GPs. The main things can be

carried out by other health professionals.'

How GPs may take on an expanding role in obesity management

1 Dorset 'Shape Your Life' programme

High-risk obese patients identified through GP registers and offered weight management schemes or walking groups.

Three-quarters lost some weight, a third lost 5kg or more and the majority achieved a reduction in blood pressure.

2 National pedometer

pilot

Department of Health and British Heart Foundation distributed 10,000 pedometers across 135 PCTs in deprived areas of the country.

GPs now able to prescribe a pedometer to any patient at high risk of obesity.

3 Wirral fruit and vegetable scheme

GPs in Wirral, Merseyside, carried out a 10-week pilot of prescribing fresh fruit and vegetables to patients, funded by local government and PCTs.

Patients at high risk of CHD received vouchers to exchange for fresh produce at a local store.

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