‘Preventing disease will reduce GPs’ workload’
The head of Public Health England speaks to Caroline Price about plans for GPs to take the lead in averting ill health
Duncan Selbie is visibly rattled. The chief executive of Public Health England has just endured a grilling from Pulse and has reluctantly agreed to pose for his photograph.
But perhaps his slightly grumpy demeanour is justified. Mr Selbie is charged with turning a health service traditionally not good at preventing illness into the lean, healthy-living promoting machine envisaged in NHS England’s Five Year Forward View. It is a big job.
But PHE’s approach has not gone down well with most GPs. Plans for practices to screen millions under the Diabetes Prevention Programme baffled a profession already struggling to keep up with the day job.
And the NHS Health Checks scheme has been criticised by MPs, with the RCGP calling for it to be suspended.
But when confronted with these criticisms Mr Selbie is resolute. GPs are at the centre of his plans, he insists, and will benefit in the long run.
A recent PHE study showed diet is now a bigger risk factor in terms of illness than smoking. What are your plans to tackle this?
I used to be chief executive of an acute teaching hospital and we were just dealing with what came through the door. [But] now I’m concerned with what we can do to prevent that. The object of the Diabetes Prevention Programme is to see if we can slow down the conversion rate of the people who are pre-diabetic. Evidence suggests this programme could avoid almost a quarter of those going on to develop type 2 diabetes.
This scheme has been criticised by experts who say it’s too narrow, the benefits are overestimated and it could lead to overmedicalisation.
If we were only doing that, then I would share that concern. When you look at the evidence, it shows this programme can make a difference. We’re piloting this in seven parts of the country and the object is to find out how best to implement it. There are specific populations we do want to reach and we want to learn how we can do that over the next 12 to 18 months. General practice is crucial to that. I’m confident GPs – as they always have done – will follow best practice, so we hope they’ll be very cautious about their overmedicalisation concerns.
But what about introducing a tax on sugary food and drinks?
You’re making a great point. Diet is hugely important. We recommended back in the summer that the proportion of our nutritional intake from sugar should be halved, to 5%. This is a monumental moment for the Government, which has accepted this as a new standard. Alongside this, PHE has conducted a meta-analysis of what works, looking at reformulation of food, advertising, marketing, price, availability and accessibility. We have submitted this evidence to the Government and they are considering it and have committed to an obesity strategy by the end of this year.
So will there be a 20% tax on sugary drinks?
I’m not going to say yes, because I think the Government is entitled to a period of reflection. Evidence suggests the most important [approach] is reformulation of food. There are countries that have looked into price but there’s little published evidence about its effect.
The RCGP recently called for the NHS Health Checks programme to be stopped until you have evidence it works. Will you consider this?
We know that two-thirds of deaths in under-75s are amenable to prevention. And the programme is focused on the population, aged 40 to 75, at greatest risk of early avoidable death. In the past year, almost 1.5 million have taken this up.
There are concerns the scheme is mainly reaching the ‘worried well’. If so, is GPs’ time not being diverted from those most at risk?
You suggest NHS Health Checks are not closing the gaps on inequality; our evidence suggests it is. There will always be a range of views. [But] the programme is made up of a range of tests, each of which has been approved by NICE. The only thing that hasn’t yet been proven is, when we bundle them up in this way, do they make an even greater difference when done systematically and with a focus on those aged 40 to 75? Why? Because it’s never been done before.
We have a research strategy for the programme and, of course, if real evidence came through – not just a view or an opinion – then we would rethink the programme.
What about the £200m of cuts in public health funding; will the front line be affected?
I think there is enough money, but it’s how we choose to spend it. I would rather the cut wasn’t happening, but I have a bigger picture: the £103bn that local government and the NHS has and how we can use that money to better effect. The discussion on diabetes is a good example. We can save the NHS money, but more importantly we can save the NHS and general practice some workload by trying to avoid things in the first place.
GPs are concerned about targets to cut antibiotics prescribing, when they’re not the main problem. How do you see GPs’ role in this?
General practice has an important part to play. It’s in all of our interest, not just GPs’, that we have antibiotics to prescribe that work.
Is there a plan to publish individual prescribing data?
No, only at practice level. It’s about how you make sure the best information, evidence and guidance are there. We’ve done an evaluation with the chief medical officer on high-end prescribing and early results suggest just bringing this to GPs’ attention has an impact.
What about contractual targets?
The objective is to reduce the overall rate of prescribing, particularly of broad-spectrum antibiotics, and to reduce variation. A cold in Newcastle is no different to a cold in Southend, yet we have variations. Without being hysterical about it, getting information out and allowing GPs to compare is sensible. To incentivise good clinical practice to reduce prescription of broad-spectrum antibiotics, what’s not to like about that?
1980 - Joined the NHS
2003 to 2007 - Chief executive, South West London and St George’s NHS Trust; chief executive, South East London Strategic Health Authority
2007-2012 - Chief executive of Brighton and Sussex University Hospitals NHS Trust
Director general of programmes and performance for the NHS and subsequently the first director general of commissioning
2013 to present - Chief executive, Public Health England