Julia Darko is a GP Specialty Trainee and Academic Clinical Fellow in General Practice at Kings College London with a Masters in Public Health. She is on Twitter: @DrJuliaDarko

For several decades, recommendations have been published both nationally and internationally for better integration between public health and primary care sectors.1-4 The COVID-19 pandemic has brought this into sharper focus and demonstrated, particularly in the context of the vaccination programme, the tangible benefits of public health and primary care partnerships.5

Much has been made of better integrating healthcare services since the publication of the NHS long term plan and the advent of Integrated Care Systems (ICS). However these strategies have predominantly focused efforts on better integration between primary and secondary care services.6 There is an equally important need for innovative alliances in the realms of public health and primary care. There is a good evidence-based case for better integration of these two sectors to improve activities such as health promotion, service planning, screening and immunisation programmes, but also to contribute to health advocacy work.

There is an … important need for innovative alliances in the realms of public health and primary care.

There are many definitions that can be applied to the concepts of public health and primary care, but in essence public health deals with health improvement at population level while primary care is predominantly focused on providing the first point of access to medical care for patients.7,8

The care provided by GP surgeries represents the bulk of primary care in the UK. It is patient-facing, responsive to individual queries and dispenses practical interventions. Conversely, public health specialists usually recommend solutions by interrogating macro-data.

These two groups have typically worked in silos, meeting infrequently and exchanging ideas on occasion. Nevertheless, there are significant areas of shared goals and overlapping skills. With a growing move to create more efficient, effective and intelligent healthcare systems, more creative collaborations between these two disciplines may have wide ranging benefits for healthcare at an individual and population level.

One particular aspect of this is the approach to health advocacy. By joining forces there are greater opportunities to create an effective mouthpiece, tasked with influencing government health strategy.

By joining forces there are greater opportunities to create an effective mouthpiece, tasked with influencing government health strategy.

Beyond the current pandemic, there are a number of pressing health issues that require greater attention and action from government. These include issues such as mental health care for children, adults and marginalised groups, perinatal care, substance misuse, the health impact of poor air quality, as well as physical and sexual abuse.

Outlined below are seven practical steps towards greater health advocacy that could be facilitated through better integration of primary care and public health efforts. These are:

Thinking in community-based terms

This would involve being jointly responsible for representing a population according to a community-sized footprint. It means studying a population at a level of granularity that is neither too small nor too expansive. It also means understanding the dynamic socio-cultural interactions taking place within that population group to ensure a qualitative lens is applied to the quantitative data. By drawing on the experience of GPs and the knowledge of their catchment as well as the statistical expertise of public health specialists, a more focused and qualitative epidemiology is more easily achieved.

Identifying community health problems using a bio-psycho-social approach

The bio-psycho-social model of illness is concerned with understanding the aetiology and impact of ill-health as a result of complex interactions between the physical, psychological and social realms. Those issues that would benefit most from effective health advocacy are those most affected by these complex intersections. Public health specialists have a deep theoretical knowledge and understanding of health disparities through a bio-psycho-social lens while primary care can contribute patients’ lived experience to this. By joining forces, a more compelling case for unpicking and addressing health disparities is possible.

Forecasting using primary care and public health databases and intelligence to provide digestible epidemiological projections at community level

Both primary care and public health have vast databases containing detailed information about individual and population statistics which can be utilised to build a clear picture of need in order to plan interventions and services more effectively. In addition to this, primary care staff can provide a nuanced interpretation of patient data held within the practice. Public health specialists have access to local authority data and other national databases which add further detail to the population landscape. Existing databases such as QResearch are good examples of applying a public health template to primary care data.9 By amalgamating data, resources and skillset, it is possible to produce compelling projections of the consequences of a particular health concern to the immediate and longer-term future of a community. By pooling expertise on this, reports can be geared towards both individuals within a population as well as policy makers.

Collaborating with patient involvement groups

Furthermore, generating more joint working between public health and primary care could pave the way for more patient involvement in health advocacy activities. It is important to create opportunities for patients to be proactive stakeholders in awareness raising and lobbying for particular neglected health concerns by partnering with them in this. By joining primary care and public health forces, patient voices could be heard on a bigger platform.

It is important to create opportunities for patients to be proactive stakeholders.

Integrating existing networks

In order to facilitate better integration and in turn better health advocacy, communication channels between existing professional networks need to be strengthened. Examples of this could include creating enhanced opportunities for networking and skill-sharing through jointly held conferences or dual-training options.

Adopting a strategic and operational approach to generating funding, cultivating political buy-in and building patient trust

By generating greater overlap between the workforce and workplace of primary care and public health systems, this can more effectively facilitate joint strategy planning to target root causes such as funding deficiencies. By adopting a more proactive stance in advocating for community health concerns, this will also result in the desirable side effect of fostering patient and population trust in both primary care and local public health staff.

Demonstrating transformational community-based leadership

Developing better joint working between primary care and public health services should be underpinned by a strong shared vision to radically improve the health outcomes of the communities they serve.

The vision should be shaped by the need within the community and driven by the desire to achieve tangible improvements in health and wellbeing.

In conclusion, the potential benefits for more co-working in public health and primary care are numerous and could in particular lead to more co-ordinated efforts towards effective health advocacy. It is time for stakeholders in both disciplines to seek more avenues to consolidate shared activity.

References

1. WHO. Declaration of Alma-Ata, International Conference on Primary Health Care. Geneva: World Health Organization.1978.
2. WHO. Ottawa Charter for Health Promotion. Geneva: World Health Organization. 1986.
3. Levesque J et al. The interaction of public health and primary care: functional roles and organizational models that bridge individual and population perspectives. Public Health Reviews 2013;35(1):1–27.
4. Rechel B. Integrating primary care and public health. Eurohealth. 2020;26(1):20-4.
5. Pettigrew L et al. Where’s the integration between public health and primary care in the response to covid-19? BMJ Opinion. Feb 2021. https://blogs.bmj.com/bmj/2021/02/18/wheres-the-integration-between-public-health-and-primary-care-in-the-response-to-covid-19/. [Accessed August 2021].
6. NHS. The NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk/wp-content/uploads/2019/08/nhs-long-term-plan-version-1.2.pdf. [Accessed August 2021].
7. Acheson D. Public Health in England: The Report of the Committee of Inquiry into the Future Development of the Public Health Function. Department of Health. London: Stationery Office Books; 1988.
8. NHS England. Primary Care Services. https://www.england.nhs.uk/get-involved/get-involved/how/primarycare/. [Accessed August 2021].
9. QResearch database. www.qresearch.org. [Accessed August 2021].

 

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