GPs and the BMA have expressed concern over the confusion that will arise from Government plans to delegate responsibility for tackling public health issues such as substance abuse, mental health and obesity to local authorities.
According to the Government's response to the consultation on its plans for public health policy, local authorities take on new responsibilities with the support of a new body Public Health England, which will replace the Health Protection Agency in April 2013.
The NHS will continue to commission aspects of public health such as immunisation, screening and health visiting for children up to the age of five, but local authorities will take on responsibility for mental health, sexual health and obesity programmes.
GP Dr Paul Singer, who is currently chair deputy of Luton shadow consortia, expressed concern over who would take responsibility for key public health issues.
He said: ‘I'm concerned about the loss of accountability – when there's work that needs to be done, is it the local authority or the clinical commissioning consortia which takes precedence? How will public health professionals decide where the priorities are when they're responsible to two different organisations?'
‘We will need to look to organisations who have already fully integrated the new model for examples on how to make public health provision work in future.'
The BMA has warned that tackling high rates of obesity, alcohol misuse and sexually transmitted infections, should be placed high on the Government's health agenda, but raised concern about how these will be handled under the new system.
Co-chair of the BMA's Public Health Medicine Committee, Dr Keith Reid, warned that unless the Government protects public health expertise during the reforms, local authorities could face a 'brain drain'.
He said: ‘I am concerned that no matter how ambitious and bold the vision in the White Paper may be, there will be very few specialists left to take forward these plans and tackle these vital health issues.'
‘We do not want a situation where local authorities are handed the keys to public health, only to find that the engine has gone.'
Local authorities' new responsibilities will include:
- ‘tobacco control;
- alcohol and drug misuse services;
- obesity and community nutrition initiatives;
- promoting exercise;
- assessment and lifestyle interventions as part of the NHS Health Check Programme;
- public mental health services;
- dental public health services;
- accidental injury prevention;
- interventions to reduce and prevent birth defects;
- campaigns to prevent cancer and long term conditions;
- initiatives on workplace health
- supporting, reviewing and challenging delivery of key public health-funded and NHS-delivered services such as immunisation programmes
- comprehensive sexual health services
- initiatives to reduce seasonal mortality
- dealing with health protection incidents and emergencies
- promotion of community safety, violence prevention and response
- initiatives to tackle social exclusion'
The public health services budget will also fund the NHS to commission the following: ‘immunisation programmes, contraception in the GP contract, screening programmes, public health care for those in prison or custody and children's public health services from pregnancy to age 5 (including health visiting)'.
A new public health outcomes framework will be published later this year.
