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PCTs underfund enhanced services

Government plans to force GPs to 'nanny' and 'guilt-trip' patients into better health could backfire and cause patients to rebel, public health experts warn.

Under a scheme due to be unveiled in next week's public health white paper, GPs will have to draw up a personal health plan for any patient who requests one.

But a new policy analysis from the Health Services Management Centre at the University of Birmingham shows GPs 'preaching' to patients about lifestyle can 'provoke resistance' and increase reluctance to seek medical attention.

GPC negotiators said they would wait until further details on the Government proposals were available before deciding whether GPs should boycott the plans.

But Dr Richard Vautrey, one of the negotiators, said patients would not welcome being 'bullied' and the plans, revealed by Pulse last week, would not be as popular as the Government anticipated.

Research shows GP lifestyle advice can have a 'negative effect', the new paper found, engendering feelings of 'responsibility and guilt' and making patients less likely to consult their doctor.

Paper author Dr Perri 6, senior research fellow at the centre, said personal health plans were only likely to help the worried well. 'I'm far from convinced that this is going to work in maximising health,' Dr 6 said.

'As I understand it, this is going to be voluntary but the evidence we have for schemes without any incentives attached is that those in greatest need don't come forward.'

GPC public health spokes-man Dr Chaand Nagpaul, a GP in Stanmore, Middlesex, said GP consultations did not lend themselves to adequate dialogue about complex life-style issues.

'We need to demedicalise personal health plans,' he said. 'People see their GP about illnesses and it's not helpful to mix the issue of health care with health promotion.'

The Birmingham paper warned 'vast resources' were needed to sustain public health initiatives, a view echoed by the BMA's public health committee, which said last week that public health plans faced disarray because of a shortage of doctors and cash.

By Emma Wilkinson

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