Topics: Public health, Health care, Health Pages: 23 (5286 words) Published: January 26, 2014
Quality in Primary Care 2011;19:317–23

# 2011 Radcliffe Publishing

Discussion paper

Health promotion and ill-health prevention:
the role of general practice
Stephen Peckham BSc MA (Econ)
Reader in Health Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

Alison Hann BA(Hons) PhD
Lecturer in Public Health and Health Policy, School of Health Sciences, Swansea University, Wales, UK

Tammy Boyce PhD
National Centre for Infection Prevention and Management, Imperial College, London, UK

Background This paper reports on research
undertaken for the King’s Fund inquiry into quality
in general practice and examines the health promotion role of the general practitioner. Methods Literature review of health promotion
in general practice focusing on smoking cessation,
childhood immunisation, coronary heart disease
(CHD) and obesity. In addition the paper draws
on interviews with practice and public health staff.
Results General practitioners (GPs) and their practice teams have a crucial role in promoting health and preventing disease. Consultations provide an

ideal opportunity for preventing illness and disease
but general practice focuses primarily on secondary
prevention. Many GPs state they lack the skills
needed to deliver effective health promotion.
Conclusions Issues, such as GP commissioning,
provide a new set of challenges for public health and
ill-health prevention. The evidence base is growing
but general practice, public health and academics
need to work together to improve this.
Keywords: general practice, health promotion,
public health

How this fits in with quality in primary care
What do we know?
Primary care is seen as a key building block of public health and there is increasing interest in extending and incentivising the public health role of GPs.
What does this paper add?
These are significant challenges to ensure that good quality prevention and health promotion services are delivered within general practice. These include expressed lack of skills among GPs, reorganisation of health services, the changing workforce and the lack of evidence for effectiveness or cost-effectiveness for many public health interventions in general practice.

There has been a growing interest in the role of
primary care and general practice in public health,
with primary care seen as a key building block of
public health.1,2 In the UK, general practice remains

the most accessed part of the healthcare system,
occupying a unique position to both provide medical
care and promote the health and wellbeing of patients.
There are over 300 million GP consultations per year


S Peckham, A Hann and T Boyce

in the UK and in a two-week period 15% of the
population see a GP. GPs are seen as ‘key agents’,
uniquely placed to do a great deal more in public
health.3–5 Tannahill argues that public health in primary care incorporates clinical and non-clinical dimensions and challenges GPs to be more proactive in addressing their patient population’s needs.6 This

view is supported by the new Coalition Government
which has identified the need to extend the public
health role of GPs and intends to further incentivise
public health activity through the Quality and Outcomes Framework (QOF).7 In 2010 the King’s Fund inquiry into the quality of
general practice commissioned a number of working
groups to review and report on aspects of general practice.8 This paper reports on the findings of a review of health promotion in general practice9 and discusses
these in relation to the quality of general practice
provision in the UK and how these findings relate to
current proposals in England to reorganise the funding
and delivery of public health. The paper initially examines the historical context of the delivery of public health in general practice and then presents a summary of the King’s Fund review...

References: Geneva: WHO, 1978.
WHO, 2008.
4 Tudor-Hart J. A New Kind of Doctor. London: Merlin
Press, 1988.
The Stationery Office, 2010.
London: The King’s Fund, 2011.
NIHR SDO, 2010.
Nursing for Public Health: population-based care. Edinburgh:
Churchill Livingstone, 2000, pp
Macmillan, 2003.
Wanless D. Securing Good Health for the Whole Population. London: HM Treasury, 2004.
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