Better health for all: public health and general practice working together

Kevin Fenton

doi:10.3399/bjgp25X740541

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Public health and general practice working together
Luke N. Allen, Eleanor Turner-Moss, Kathrin Thomas, Luisa Pettigrew, David Blane, Rory Honey, Richard Hobbs and Aziz Sheikh

Published on: 14 February 2025

Published on: (14 February 2025)
Page navigation anchor for Public health and general practice working together
Public health and general practice working together
Luke N. Allen, GP and Co-Director of Global Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford
Other Contributors:
Eleanor Turner-Moss, Co-chair, GP & Public Health Registrar, Faculty of Public Health special interest group on public health and primary care

Kathrin Thomas, Co-chair, and Public Health Lead for Deep End Cymru, and Honorary Research Fellow at Cardiff University

Luisa Pettigrew, GP and Doctoral Research Fellow, Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine

David Blane, GP, Academic Lead for Deep End Scotland, and Senior Clinical Lecturer, School of Health & Wellbeing, University of Glasgow

Rory Honey, GP & Deputy Medical Director, Torbay & South Devon Foundation Trust

Richard Hobbs, Mercian Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford

Aziz Sheikh, Head of Department and Nuffield Professor of Primary Care Health Sciences, University of Oxford
Kevin Fenton's call for deeper collaboration between GPs and public health will evoke mixed feelings.¹ To be clear; GPs already hold responsibility for the health of local communities as well as individual patients.² General practice has a strong tradition of public health action and we already deliver vaccinations, screening, risk stratification, lifestyle counselling and a range of other preventive actions. However our current training, contract, and resourcing makes little room for ‘national advocacy’, ‘system leadership’, fostering ‘community participation’, and ‘co-creation’ of interventions with disadvantaged groups i.e. community-level actions to tackle inequalities and the social determinants of health.¹

Some GPs feel that we have no business in these upstream areas;³ others feel that we have a vital, synergistic contribution to make⁴ but may not know how or where to start; and a small minority are already actively engaged, despite rather than because of current system incentives. All GPs are united by a crushing paucity of time, resources, and mental bandwidth. These pressures are most acute in socioeconomically deprived areas.

We need to recognise that primary care and public health teams have overlapping but distinct remits, and that most GPs aren’t trained or equipped to undertake the work of public health professionals. From this dep...
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Kevin Fenton's call for deeper collaboration between GPs and public health will evoke mixed feelings.¹ To be clear; GPs already hold responsibility for the health of local communities as well as individual patients.² General practice has a strong tradition of public health action and we already deliver vaccinations, screening, risk stratification, lifestyle counselling and a range of other preventive actions. However our current training, contract, and resourcing makes little room for ‘national advocacy’, ‘system leadership’, fostering ‘community participation’, and ‘co-creation’ of interventions with disadvantaged groups i.e. community-level actions to tackle inequalities and the social determinants of health.¹

Some GPs feel that we have no business in these upstream areas;³ others feel that we have a vital, synergistic contribution to make⁴ but may not know how or where to start; and a small minority are already actively engaged, despite rather than because of current system incentives. All GPs are united by a crushing paucity of time, resources, and mental bandwidth. These pressures are most acute in socioeconomically deprived areas.

We need to recognise that primary care and public health teams have overlapping but distinct remits, and that most GPs aren’t trained or equipped to undertake the work of public health professionals. From this departure point, we would argue that there are definite areas of community-level action where GPs have an underdeveloped, but potentially strategic role to play; pushing into complementary rather than duplicative roles that draw on our unique strengths.

To meaningfully act beyond the consultation room, GPs need time, resourced opportunities, and relationships. At the most basic level, every GP should know who their local public health team is and be able to contact them easily. This isn’t currently the case. Many GPs have special interests in lifestyle medicine, de-prescribing, homelessness, migrant health, safe housing etc, and would value opportunities to learn about, feed into, and get involved with local programmes of work. Public health teams could share opportunities for collaboration directly with local practices, with clear and specific asks.

In a similar vein, public health teams have an important role to play in linking GP and community voices with local and national policymakers. Our sense is that GPs have lots of valuable insights and stories to share, but don’t necessarily know how to go about engaging with relevant decision-making bodies. Public health teams could make a big difference by proactively seeking out relevant evidence and helping GPs navigate the system. Deliberately fostering relationships with GP network/cluster leads through existing opportunities like funded Health Board/Integrated Care Board (ICB) training afternoons would also help, particularly if some of these sessions were used to collaboratively identify local priorities.

There are clear opportunities for joint learning sets during speciality training, and many practices would welcome opportunities to host embedded public health registrars during their training. The nascent GP & public health dual training programme has 112 applicants for every one place⁵ and clearly needs expansion. Post-qualification, courses on core public health topics that align with primary care contractual targets would likely go down well with jobbing GPs, especially if they are simple to access, use EMIS/SystmOne examples, provide CPD for annual appraisals, and are developed with primary care input. Individual support would be helpful for those GPs in strategic roles (e.g. cluster/network leads) who feel out of their depth with population health. The Faculty of Public Health (FPH) should seek to expand opportunities for collaboration with the RCGP, and vice versa, minimising barriers to access to joint educational events, training programmes and forums that can stimulate collaboration and innovation.

It would be great to see more opportunities for emerging leaders. For example, reintroducing Health Education England Population Health Fellowships, expanding prevention-focused primary care roles within ICBs and Health Boards, and having the FPH actively invite GP leaders to contribute to policymaking and advocacy activities. Ideally, we would have a more systematic training offer for public health primary care leaders, greater collaboration within academic departments, and more posts for GPs with an Extended Role in Population Health and Health Inequalities.⁶

Many GPs would relish opportunities to work with local populations and public health teams to develop and co-lead community initiatives to tackle inequalities, but may need help identifying funding, collaborators, and open policy windows. The move towards seamless collaboration will also require structural reforms to data sharing, resource allocation for joint-working, and greater clarity around roles and formal communication pathways.⁷

We believe that GPs and our wider primary care teams have valuable and largely unrealised contributions to make at the community-level. However, our focus is constrained to the consultation room by misaligned incentives and unremitting system pressure. Without resourcing, time, and clear opportunities to contribute, the status quo will prevail.

References

1. Fenton K. Better health for all: public health and general practice working together. Br J Gen Pract 2025, 75(751):55-56. doi: 10.3399/bjgp25X740541.
2. RCGP. GP curriculum update. August 2024. Available at: www.rcgp.org.uk/mrcgp-exams/gp-curriculum/gp-curriculum-update-notice.
3. Martin et al. Sacrificing patient care for prevention: distortion of the role of general practice. BMJ 2025;388:e080811
4. Allen LN, Barkley S, De Maeseneer J, Van Weel C, Kluge H, de Wit N, Greenhalgh T. Unfulfilled potential of primary care in Europe. BMJ 2018 Oct 24;363.
5. NHS England. Competition ratios for 2024. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2024-competition-ratios.
6. RGGP. Introduction and overview of GPwER in Population Health and Health. Aug 2024. Available at: www.rcgp.org.uk/your-career/gp-extended-roles/population-health-inequalities-introduction
7. Allen LN, Rechel B, Alton D et al. Integrating public health and primary care: a framework for seamless collaboration. BJGP Open 2024 Dec 1;8(4).
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Competing Interests: None declared.