Select Committee on Health Minutes of Evidence


Memorandum by The NHS Alliance (PH 81)

PUBLIC HEALTH FUNCTIONS OF PRIMARY CARE GROUPS AND TRUSTS


BACKGROUND

  1.  The public health function within a PCG/Ts needs to include the following elements:

  1.1  Improving health and reducing inequalities through HimPs.

  1.2  Developing partnerships and community involvement jointly with the local authority.

  1.3  Informing the commissioning of services (best practice, best value and evidence).

  1.4  Clinical governance—development and use of better information systems for disease surveillance and quality control of service delivery.

  2.  This is a very broad range of functions which can be divided into two components:

  2.1  A community focused public health function which needs to deliver reductions in inequalities and improvements in health through partnership and community involvement (1.1 and 1.2 above).

  2.2  A narrower specialist public health function which encompasses 1.3 and 1.4 above.

  3.  The NHS Alliance is concerned about the current emphasis on the narrow specialist function at the expense of the broader function. The move to PCTs and their need to develop robust and effective commissioning and governance structures is likely to increase this emphasis which the Alliance feels has the following significant disadvantages.

  3.1  It will foster a medical rather than a social model of health care, at a time when there needs to be a more effective balance between the two models.

  3.2  It will become increasingly absorbed in secondary care commissioning and performance management at the expense of a broader approach.

  3.3  It will not place enough weight on developing local community involvement.

  3.4  It will not place enough weight on building public health capacity within the PCG/T, in particular in developing the role of non-medical public health specialists, health visitors and school nurses.

  3.5  It will not devote sufficient time to ensuring that primary care teams and practitioners incorporate public health perspectives within their daily work.

  3.6  It will not have sufficient time to devote to effective inter-agency working, which is essential if inequalities in health are to be effectively addressed.

  4.  The alternative approach is to develop the PCG/T public health function as a generic locally based resource in partnership with Local Authorities who have a lead responsibility for community plans and neighbourhood renewal. The Alliance believes that this approach will result in less discussion of what should happen and more real change, which engages with the needs of front line professionals and the communities they serve. This is particularly true of PCG/Ts serving disadvantaged communities and the remainder of this paper describes an approach adopted by Newcastle West PCG.

PUBLIC INVOLVEMENT

  5.  Newcastle West PCG has actively supported community involvement since it first became a locality commissioning group in 1994. This has resulted in the formation of Community Action on Health, which is an independent project with charitable status. The committee is composed of local people elected annually from nominations from community groups. Two members of the committee have been elected to be community representatives with a shared vote on the PCG Board and they are supported by 1.5WTE Health Development Workers.

  6.  Community Action on Health has the following functions:

  6.1  Support to local people and community groups who wish to raise issues or concerns and/or to lobby for the development of new services to meet community needs.

  6.2  Maintaining and managing a network of over 90 community groups and projects who all have an interest in health issues.

  6.3  Support to a number of high priority projects which have recently included the West End Youth Enquiry Service, A Community Care Information Project and the Black Mental Health Forum.

  6.4  Advocating for the community voice at a number of forums and meetings.

  6.5  Running an Annual Community Conference which provides an opportunity:

    —  for local people and groups to get together to talk about their health issues, and about what action can be taken, that will make a difference;

    —  for professionals to listen to the community's voice;

    —  to increase the community's sense of confidence and power to act; and

    —  to be an opportunity for groups to make useful links with each other.

  7.  The Annual conference is always workshop based around priority areas and the task of the workshops is to identify action points. For example a workshop on Drugs and Alcohol—a health issue for the wider community identified the following action points:

    —  put more resources into community based organisations;

    —  develop education for everybody, including parents, done sooner at school, even down to nursery age;

    —  use the experience and knowledge of users and ex-user, like "Choose Life" does, at service and policy level;

    —  train staff to offer an appropriate, non-stigmatising service; and

    —  train GPs to ease the strain on secondary services.

  8.  This model successfully developed within one PCG has now been rolled out across the other two PCGs in Newcastle and there is also a post which has a city-wide co-ordination function.

  9.  Recommendation. Public involvement should go beyond the token appointment of lay members to PCG/T Boards. There need to be mechanisms for developing local community networks who nominate accountable representatives. The networks and their nominees should be supported with resources, preferably through a dedicated organisation accountable to the local community. This will enable PCG/Ts to truly engage with the communities they are designed to serve. Public involvement at all levels of the organisation should also be promoted as part of best practice with lay representation on the Executive Committee of PCTs.

PUBLIC HEALTH

  10.  Newcastle West PCG has a Public Health Sub-Group which is accountable to the PCG Board. This group is chaired by an academic GP who is a co-opted Board member. The group has the following membership:

    —  Public Health Nurse for the PCG;

    —  Health Promotion Specialist;

    —  Member of Community Action on Health;

    —  Health Visitor who is the PCG Board Representative;

    —  Senior Nurse Communicable Disease Control;

    —  Senior Non-Medical Public Health Specialist from the Health Authority;

    —  LA Regeneration Manager;

    —  PCG Public Health/Regeneration Manager; and

    —  Specialist Health Visitor for Refugees and Asylum seekers from the Health Authority.

  11.  The Public Health Sub-Group has the following responsibilities.

  11.1  Developing effective links with local initiatives such as Sure Start, New Deal for Communities, Regeneration Partnerships and HAZ. This is the specific remit of the PCG Public Health/Regeneration manager who is jointly funded by the PCG and the Local Authority.

  11.2  Developing public health capacity in the PCG by increasing the skills and competencies of primary care nurses. This work is led by the PCG Public Health Nurse.

  11.3  Developing and delivering new local initiatives that meet HimP priorities. Work within other PCGs has demonstrated that locality strategies (HimPlets) are more likely to produce robust and sustainable change that can then be rolled out to other areas.

  11.4  Working with Community Action on Health to ensure that priorities identified by the local community are addressed.

  11.5  Addressing new and emerging priorities such as the needs of refugees and asylum seekers.

  This is a large remit which does not include commissioning of services and clinical Governance. These functions are the responsibility of other PCG Committees.

  12.  Examples of work that has been developed in these areas includes:

  12.1  A HAZ National Employment Pilot in partnership with Newcastle College, Employment Services and the three Newcastle PCGs. This project is identifying training placements in general practice for full time New Deal trainees who will be trained to NVQ Level 2 in Customer Services or Admin by Newcastle College;

  12.2  Employment of two specialist nurses, one for Child and Adolescent Mental Health to work with GPs, Health Visitors and School Nurses and the other for Young People and Substance Misuse who is responsible for developing locality initiatives to address these problems;

  12.3  Development of a very successful community based coronary rehabilitation programme which is run from a Healthy Living Centre (the West End health Resource Centre) and has increased uptake of coronary rehabilitation from 15 per cent to 85 per cent. This programme is now being rolled out across two other PCGs; and

  12.4  Development of a PMS Pilot Project for Refugees and Asylum seekers.

  13.  The Alliance is aware of other similar work going on around the country in Southampton, Birmingham, Nottingham, London and Mid-Devon. The success of this work appears to have two key components.

  13.1  The willingness of PCG/Ts to engage effectively with their local communities and with Local Authorities and other partners so that sometimes sterile HimP Strategy documents can be converted into effective locality based services which make a real difference to people's lives.

  13.2  The ability of PCG/Ts, or individuals within them, to make the best of the opportunities available to gamer additional resources to support community involvement and local innovation.

  14.  Recommendation. Resources should be invested in the delivery of HimPs at the level of localities and PCG/Ts. These resources should be used to release people within the local system so that they can use their creativity and local networks to develop robust and sustainable services which meet needs identified by the local community. There should also be more structured opportunities for shared learning and mutual support. Access to these resources should be dependent on being able to demonstrate high levels of community participation and partnership with the Local Authority.

Philip Crowley, Community Action on Health, Newcastle upon Tyne

Professor Chris Drinkwater, Public Health Lead, Newcastle West PCG, for the NHS Alliance.


 
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Prepared 1 February 2001