GPs split on lifestyle advice role
By Daniel Cressey
GPs are increasingly expected
to take on the role of lifestyle guru, with barely a week going by without a call for practices to become more active players in public health.
NICE draft obesity guidance is the latest to drive the point home, insisting GPs must implement 'multi-component interventions' to promote diet and exercise.
Only last week, ministers announced they wanted the QOF to incentivise 'well-being interventions' taking the role of the GP into uncharted territory.
But not all GPs are happy to have a greater public health role thrust upon them.
While some argue the GP is ideally placed to implement lifestyle interventions, others ask whether they became doctors to spend their time nagging people about their lifestyle.
Dr Philip Rathbone, a GP in Melton Mowbray, Leicestershire, belongs to the latter camp. He says: 'It is something I get increasingly irritated by. In order to promote health we make people afraid.
'Even if we do have a strategy that is helpful you reach a point where you're interfering with a person's liberty.'
Dr Des Spence, a GP in Glasgow, agrees, arguing that the current focus on lifestyle is 'counter-productive'. He says: 'It's more an issue for the public health department. The thing is we're not lifestyle police. Quite often the nagging and slightly teachery approach can really turn people off.'
With lifestyle choices impacting on clinical outcomes that thanks to the QOF influence GP pay, the line between helpful advice and bullying is increasingly blurred.
'It has been exacerbated by the QOF,' Dr Rathbone adds. 'GPs are being paid to pester people. I don't think smoking is a good idea but it's a decision people make for themselves.'
Dr Karen Jochelson, fellow in policy at the King's Fund, takes a very different view, insisting it would be a 'dereliction of duty' not to address patients' lifestyles in consultations.
'Lots of studies of smokers found most wanted to give it up. It would be different if they were forcing it on people. Wouldn't you argue it was a dereliction of a doctor's duty if they have a severely obese patient and don't mention diet?'
Dr Martin Breach, a GP in Haydock, Merseyside, agrees: 'We're caught at that interface between public health policy and the individual patient's concerns. It's inevitable we do have a role in public health. We're a potential big influence on patients.'
Increasing numbers of GPs are taking their enthusisam for lifestyle interventions to a new level by specialising in public health issues.
Dr David Haslam, a GP in Hertfordshire and clinical director of the National Obesity Forum, is one. He says: 'There is an increasing public health role in general practice. We don't want to interfere in personal choice but we do need to advise on it. We must have the ability to attempt to intervene.'
Dr Nick Summerton, reader in public health and primary care at the University of Hull and a GP in the city, says: 'One of the reasons I went back into general practice is as a GP you have a bit more credibility in getting people to make a healthy choice.
'The approach I tend to adopt is a partnership with the patient. If you're just going to give people statins and you don't deal with smoking you're keeping one eye closed.'
But even if the principle of intervention is not disputed, how GPs are encouraged to do it is, particularly with reference to the QOF.
Some GPs insist the evidence is not there for the majority of public health interventions.
Dr Laurence Buckman, dep-uty chair of the GPC, accepts GPs have a role in public health. 'There is definitely a role and there are contractual devices to deliver that. But the QOF is not a vehicle for delivering public health. It's for individual care.
'If you want public health to change you don't change it in one individual.'
GPs' growing public health role
April 2005 Government announces launch of national pilot of GP screening for alcohol misuse
January 2006 GPs will be expected to create register of obese patients under revised QOF
February 2006 NICE draft guidance says GPs should offer yearly quitting advice to all smokers
March 2006 Government says it wants QOF to incentivise 'well-being interventions'
March 2006 NICE draft guidance insists GPs should implement 'multi-component interventions' to promote diet and exercise