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Analysis: Evidence GPs can change lifestyle is lacking

There have been many calls for GPs to take a more active role in promoting better health, but it looks like this Government is getting serious.

The proposal to ring-fence a proportion of the QOF and devote it to public health is a significant shift in the direction signalled by the Government's 2010 public health white paper.

This said that at least 15% of the current value of the QOF should be devoted to ‘evidence-based public health and primary prevention indicators' from 2013, with funding from Public Health England.

This was taken forward by the NHS Future Forum earlier this year, when it said GPs should be incentivised through the QOF to support patients to ‘eat more healthily, exercise more or access weight-loss support'.

It emerged this week that the GPC and NHS Employers are now negotiating on which indicators will fall under this new domain – including existing ones on smoking and obesity.

The GPC insists the move will not mean any additional work, but it remains to be seen how the Government plans to ramp up the work that GP practices have to do in future years to persuade patients to modify their lifestyle. The latest proposals will have various lobby groups daydreaming of a raft of new indicators, but such calls should come with a health warning attached.

Interventions in patients with low levels of physical activity or problem drinking will involve a large number of patients, and the evidence that GPs can encourage lifestyle change is patchy at best. 

As the recent analysis of the DESMOND trial in diabetes showed, even those who have an active interest in living more healthily need access to sustained support rather than simply a brief intervention after diagnosis.

A recent analysis cited the MRFIT trial in patients at risk of cardiovascular disease as an example of how interventions should be designed, with patients having two initial screening sessions and then 10 weekly group sessions and annual assessments to discuss managing their risk factors.

That will require a lot more investment than shuffling around a few QOF points.