Blog: population health, prevention and the NHS Long Term Plan
Dr Rory Honney, GP Principal St Mary’s Surgery, Andover, blogs about what GPs in Mid and North Hampshire are doing to combat health issues, and how this links into wider NHS plans across the local area, as well as nationally.
Non-communicable diseases (NCDs) largely made up of; heart disease, stroke, diabetes, cancer, chronic respiratory disease, account for 71% of all deaths globally each year (1). The risk factors for these conditions are broadly similar and well known: physical inactivity, smoking, unhealthy diets and over consumption of alcohol. The World Health Organisation (WHO) estimate that, “If the major risk factors for non-communicable diseases were eliminated, [approximately] three-quarters of heart disease, stroke and type 2 diabetes would be prevented; and 40% of cancer would be prevented.” (2) In primary care we discuss these issues with patients every day. Primary care and public health are natural bedfellows (3). However, change cannot be achieved in the consultation room alone.
The highly anticipated NHS Long Term Plan (4) was published late last year after some lengthy delays. The plan sets out the vision for the NHS over the coming decade. It was encouragingly peppered throughout with a growing recognition of the importance of preventing disease. Promoting health and preventing disease not only support people to lead happier, healthier lives but in turn contribute to the sustainability of the NHS by reducing unnecessary demands on the health system.
The Sustainability and Transformation Partnership (STP) for the Hampshire and Isle of Wight is the comparatively recent (yet soon to change again) terminology to describe the group of health and social care organisations working together across the region to deliver continued improvements in health and care. The STP has just submitted plans to NHS England detailing how it will deliver the aspirations of the NHS Long Term Plan locally. The section of the plan focusing on disease prevention is bold and rightly so. Without greater efforts to tackle the wider determinants of health and unhealthy lifestyles, the pressures on our hospitals and GP surgeries will continue to mount.
Commissioning lifestyle services such as weight management and smoking cessation programmes is core work of public heath teams. With the move of public health from primary care trusts to local authorities with the 2013 Lansley Reforms, it felt to some that a disconnect arose between public health and the NHS. However, having worked in local authority public health teams, the co-location with colleagues in departments as diverse as transport to housing and social care has provided a real opportunity to influence those wider determinants of health so key to creating healthy populations. Continuing to build on and develop these links across Hampshire and the Isle of Wight will be critical for the STP and NHS partners to achieve the disease prevention aims they aspire to in the Long Term Plan.
Language is important. Public health, famously defined as, “the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society” (Acheson, 1988; WHO) has, over the last few years, started to be used interchangeably with presumed synonyms, most notably ‘Population Health’ and ‘Population Health Management’ (PHM). The King’s Fund, however, rightly points out it is important we acknowledge these terms are talking about different, albeit closely related concepts (5).
PHM is an exciting tool used by health planners which draws on large amounts of data to better understand the health needs of their population and guide how to effectively invest limited resources where they are most needed. The Mid and North Hampshire system is exploring a PHM style project called ‘The Top 5,000’ using learning from colleagues in Hillingdon. The project is looking to understand an array of population and hospital level data to risk stratify individuals who may benefit from more intense support in the community and in doing so reduce non-elective hospital demand, thus releasing resources for the wider system. However, as exciting as this work is, it is in no way adequate short hand for the far wider remit of public health. PHM seeks to improve the health outcomes of a group of individuals in a defined geography and place, which appreciates the importance of addressing the wider determinants of health, and integrating health and social care to achieve these aims and reduce health inequalities. The overlap between population health and public health is clear.
By using new terminology inappropriately there is a risk the impact of public healths’ underpinning philosophies are undermined. However, there is also an opportunity. PHM eliminates assumptions that public health is simply a defined set of commissioned services located somewhere distant and thus not our responsibility. In doing so the opportunity is to remind us that preventing disease is key to our sustainability as a health service and thus squarely our responsibility too. Language is important.
With the formation of four Integrated Care Partnerships across Hampshire and the Isle of Wight and the rapidly evolving Primary Care Networks within them, there is a tangible sense of community, of place and of populations. The opportunity now is to look ‘beyond the walls’ of hospitals and GP surgeries and appreciate the greatest gains will be through the organised efforts of our societies. In primary care we have not only an opportunity, but a responsibility, to foster and shape these healthy communities in which we are fortunate to be so deeply rooted.
- WHO https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
- WHO https://www.who.int/features/factfiles/noncommunicable_diseases/facts/en/
- Allen BJGP https://bjgp.org/content/bjgp/69/678/8.full.pdf
- NHS Long Term Plan – https://www.longtermplan.nhs.uk
- King’s Fund https://www.kingsfund.org.uk/publications/vision-population-health