The organisation and delivery of health improvement in general practice and primary care: a scoping study

Abstract

BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Health promotion and disease prevention in general practice and primary care: a scoping study

“…Findings of the review were drawn from 483 papers, in addition to information on service delivery extracted from Cochrane systematic reviews was not always easy to distinguish between primary and secondary prevention in the allocation of papers, as some interventions might appear to be primary in nature, they might have been applied in practice to patients with an existing health problem, for example CVD. In reporting the findings we predominantly draw on the synthesis reported in our substantive report (Peckham et al, 2015) except where it is useful to refer directly to specific studies.…”

“…While many screening programmes are managed nationally there are several programmes in which general practice has a role; including cervical cancer screening, NHS Health Checks, child health surveillance, diabetes and CVD screening, and health checks for people aged over 75 years. Most studies focussed on screening coverage and women's experiences, including such aspects as informed consent, reasons for non-attendance rather than aspects of how services were organised and delivered (Peckham et al, 2015).…”

“…Screening programmes for CVD, diabetes and kidney disease have become an increasingly important part of UK screening programmes that involve general practice although there is inconsistency in the way screening activities were delivered despite attempts by programme designers to standardise it (Peckham et al, 2015). The initial national health checks programme was for people with learning disabilities as distinct from the later NHS Health Checks Programme discussed below.…”

“…On the whole interventions and referrals tended to be undertaken haphazardly (by both GPs and practice nurses). Recent research on changes in the public health system in England identified a number of problems related to the organisation and commissioning of services for helping obese and overweight peopleparticularly since the reorganisation of public health services in 2013 (Peckham et al, 2015).…”

English general practice: once, twice, three times a hybrid

“…18,19 However, its public health function remains relatively underdeveloped, and clinically led commissioning is no longer seen as being able to drive through fundamental service change. 20 to what degree these various strengths and weaknesses are related to one or more of the forms of hybridity is uncertain. Wider issues such as the level of government investment, NHS restructuring, lifestyle choices made by a new generation of GPs, and political mood swings may be more crucial in practice.…”