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by Nora Elias
4 December 2018
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With NHS resources as stretched as they’ve ever been, prevention is pivotal to the service’s survival – and GP practices are at the very centre of this strategy, says editor Nora Elias
From the outset, health and sociacare secretary Matt Hancock listed prevention as one of his key priorities for the NHS. Of course, the concept of prevention is not new, but it hasn’t always been at the forefront of healthcare policy.
However, given the situation we’re now in, it’s logical for it to be at the centre of the Government’s long-term strategy for the NHS and public health. The UK population is living longer than ever, which means a growing number of people with a complex range of conditions that require treatment and medication.
With this development coinciding with what is arguably the most cash-strapped time in the service’s 70-year history, it would be a huge oversight for any long-term strategy not to consider how to reduce the degree to which people need to use the health service. After all, many of us see a GP or end up in hospital for problems that could have been prevented.
Last month, the Government announced an additional £3.5bn a year for primary and community healthcare services by 2023/24, in a preview of the NHS long-term plan. This will include funding for community-based rapid response teams consisting of doctors, nurses and physiotherapists, and additional support for care home residents.
Commenting on this, Mr Hancock said: ‘To make the NHS sustainable for the long term, we need prevention as well as cure. So we will back our GP, primary and community healthcare to help keep people healthy and out of hospital in the first place.’
It stands to reason that general practice has an essential part to play. Regardless of where in the healthcare system the patient ends up, contact with the GP surgery is the first step.
And not only can practices provide services that could reduce referrals to secondary care, they are also in a position to offer treatments that might trigger lifestyle changes and help patients remain healthy for longer.
One way in which practices play a vital part in prevention is through special clinics such as smoking cessation services.
Despite a decrease in the overall number of smokers, the habit is estimated to cause 16% of deaths in England (according to NHS Digital data published in July), with 77,900 of deaths in 2016 and 484,700 hospital admissions in 2016/17 attributed to smoking.
It has also been found to cost the NHS around £5bn a year, with smokers at an increased risk of developing conditions such as heart disease, cancer and stroke.
The smoking cessation services offered by GP surgeries could be vital not only in reducing the strain that health problems linked to smoking place on the NHS, but also when it comes to impact on public health.
Another area where practice prevention clinics are key is weight management. NHS Digital data published earlier this year shows that in 2016/17 there were 617,000 hospital admissions in England where obesity was registered as a factor, an 18% increase on 2015/16 – and that 26% of adults in England are classified as obese.
As an increasingly overweight nation – with all that implies in terms of a greater risk of developing type 2 diabetes, high blood pressure and, mirroring the risks associated with smoking of cancer, heart disease and stroke – there is little doubt that tackling this issue is essential to public health and to safeguarding the strained NHS resources.
Practices can be integral in this; hosting weight management clinics, sharing weight loss advice and supporting patients. Offering patients information on the causes of obesity and how to address them are important first steps but many would struggle to see results without an adequate support system.
GP surgeries can be central to providing this, as in the case of practices working with health trainers, whose remit includes providing encouragement and support to this patient group.
Local authority funding cuts over the past few years have forced many councils to slash public health funding – including stop smoking, weight management, sexual health and substance abuse support services. Labour party research published in September showed that more than 85% of local authorities had made cuts to their 2018/19 public health budgets.
Consequently, practices may soon be one of the few locations where people can access services such as smoking cessation and weight management for free.
It seems the Government’s purported dedication to prevention won’t necessarily be reflected in increasing or even maintaining investment in the services and authorities that could help realise this vision. Imagine that.