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Primary care under threat: time for the Government to address the urgent challenges

Primary care under threat: time for the Government to address the urgent challenges

Craig Watson, Michael and Jeavons, Charlotte (2020) Primary care under threat: time for the Government to address the urgent challenges. British Medical Journal (BMJ):2020;371:m37. ISSN 1759-2151 (Print), 0959-8138 (Online)

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Abstract

Dear Editor
We are grateful to Levene and colleagues for discussing current issues and future priorities for primary care in the post-covid-19 era.(1) However, we were surprised that health promotion, a crucial component of holistic care was not mentioned.(2)

At the First International Conference on Health Promotion in 1986 the World Health Organisation succinctly described health promotion as “the process of enabling people to increase control over, and to improve their health.”(3) Importantly, health promotion can play significant roles at all stages of wellness and disease, that is at primary, secondary and tertiary levels. But general practice has remained largely focused on secondary and tertiary.

There are considerable opportunities for promoting health in the primary care setting and many major topics can be effectively addressed. Accident prevention, exercise promotion, healthy eating, and mental health are just a few notable ones. Linked and underlying all these is the pervasive issue of inequalities.

However, there are challenges for all those working to promote health in this setting including: high workload; stress levels; recruitment and retention; lack of public health training; and balancing the needs of individuals with the needs of the population.(4-7) Some of these were quite rightly highlighted by Levene and colleagues.(1)

Working in primary care is a complex but tough occupation, nonetheless it is made harder than it should be by neglecting doctors’ health and wellbeing. Moreover, recent research has highlighted that workload pressures are increasing and that staff are showing symptoms of depression and anxiety, and high levels of stress and burnout.(6-9) These are crucial issues as they are likely to influence patient care and satisfaction, medical errors, and retention and recruitment of GPs.(6-9)

For many practices, premises, IT infrastructure and administrative support all need to be addressed.(5,10) In addition, and critically, a robust workforce strategy that is recurrently funded is required to enable expansion to meet the needs of current and future communities.(10)

We have previously described the gold standard for health promotion in this setting: the Health Promoting General Practice.(4) Essential components of this include monitoring and promoting the health of staff, and creating supportive environments. Doctors workplaces should become a model that other employers could emulate.

Primary care has for a long time been the "sleeping giant" of public health, its enormous potential to promote the health of individuals and communities has never truly been tapped.(4,11-13) We have seen some rapid ‘service shifts’ as a result of the pandemic, demonstrating progressive changes are possible, but this momentum needs to be maintained.(14)

Primary care is the cornerstone of the NHS and the setting for ninety percent of all NHS patient contacts.(5) Registration with a GP provides an important link with an individual that can last many years. There are, therefore, many opportunities for promoting the health of individuals and their families.

In addition to knowledge about individuals, many GPs have a good knowledge of their local community including information about local negative and positive factors that may influence health. This presents opportunities for practices to play more roles in tackling certain public health issues.

An underlying theme hindering practices achieving their true potential is underinvestment.(5,10,15,16) Surprisingly, in 2017, general practice was receiving just 8.1% of the NHS budget (excluding the reimbursement of drugs).(16) We believe that primary care should receive a larger proportion of overall NHS spending. The BMA general practitioners committee has called for a minimum of 11% of the NHS budget to go to general practice.(16)

The work of GPs is fundamental to the success of the NHS and key to promoting the health of individuals, families and their communities. It is imperative that we tackle the issues outlined above so that we have a revitalised profession and they can achieve all the benefits possible. It is time to invest in primary care: strong Government support is urgently needed.

Item Type: Article
Additional Information: Letter to the Editor: "Rapid response to: Pandemic threatens primary care for long term conditions, BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3793 (Published 05 October 2020)"
Uncontrolled Keywords: current issues and future priorities for primary care; health promotion; holistic care
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Faculty / Department / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > Department of Psychology, Social Work & Counselling
Related URLs:
Last Modified: 12 Oct 2020 11:08
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
Selected for REF2021: None
URI: http://gala.gre.ac.uk/id/eprint/29925

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