Feature

Working for patients – and populations too

The scope of primary care is changing – and new primary care organisations are developing local action plans for health. Stephen Peckham and Margaret Godel set out a research agenda

The face of primary care in the UK is changing – and at the centre of it all are the new primary care organisations (PCOs) and Primary Care Act pilot projects. As well as commissioning and providing services, PCOs now have a significant public health role and are expected to take the lead to improve the health of their local populations.

Since 1974 responsibility for public health has been split between local authority environmental health departments and health authorities, which identify health need, commission health care services and monitor notifiable diseases. Development of these roles over the past 25 years has been largely uncoordinated, despite international initiatives such as Health for All, Healthy City projects and Agenda 21.

Current policy calls for greater co-ordination of strategy and action between health and local authorities, and gives primary care organisations specific public health responsibilities, emphasising local, community-based initiatives such as healthy living centres, health actions zones, health parks and community-based regeneration projects.

These activities require that traditionally separate statutory organisations, including primary care, work jointly with each other, with other organisations – private and voluntary – and individuals and groups in local communities. This change in emphasis requires a wider understanding of public health, one that considers the circumstances and social reality of people’s lives. To date, however, little attention has been paid either to the public health role of PCOs or the role of communities in determining public health strategy and action.

A research team based at Oxford Brookes University will be exploring these issues over the next few years. The aim is to understand the issues and the realities of the relationships between PCOs and the communities they serve, in the context of national and local health and social policies. The research will also examine how differing lay and professional perceptions of public health inform action.

The project, funded by the National Lottery Charities Board, is a joint venture between the UKPHA, Oxford Brookes University and the University of the West of England. It builds on previous work undertaken by members of the current team. The public health model of primary care describes the overlap between primary health care, public health action and the health action of communities, and highlights the importance of equity, collaboration and participation in action to improve the health of local communities.^{1 2}

Previous research found that participative approaches provided a helpful framework for including the diverse groups that exist in any one location, and were more likely to achieve long-term health benefits. Importantly, a focus on participative community-based health activity increased the chances of marginalised groups becoming involved.

In the three years since these findings emerged a greater understanding of health inequalities has developed, including recognition that social deprivation and social exclusion must be tackled if better health for all is to be achieved.

The causes of social deprivation and social exclusion are multifaceted, however, as a result of which health policy now focuses on the need for partnership and collaborative working between health agencies, other statutory organisations and community-based voluntary organisations. Policy also addresses the need to improve public health by increasing user and public involvement in decisions and action to reduce inequalities and promote social inclusion.

Although the government is reluctant to dictate how the partnerships tackling these complex issues should work in practice, performance against centrally determined criteria and targets will affect future funding.

Against this demanding policy context, the new research will involve individuals, community groups and organisations in nine PCO areas in a variety of mutually informative activities. Each case study will explore how organisations and individuals interact over public health issues and activities, focusing on five key areas (see box).

While the research will primarily focus on work in the three case study areas, we are also interested in other activities or research on public health and primary care that involve a community perspective.

If you would like to share information or find out more about the project, contact the authors on 01865 484110 or 484292.