PCT — directors of public health

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The role of the director of public health

Directors of public health (DPH) are still relatively new posts in primary care, the role having previously been found in the health authorities (HAs) and regional offices. In the former HAs, they would have been key customers for NHS influencers as regards to their involvement in the determination of local healthcare needs. Health needs assessment has moved to PCTs in their role as the main healthcare commissioner. DPHs are important, as they will likely be taking the lead on NSFs and the implementation of NICE guidance/guidelines. Prescribing advisers and pharmaceutical advisers may also operate within this part of the PCT. NHS influencers should also be aware that the 28 strategic health authorities will also have DPHs.

Appointment of non-medic directors of public health
Unlike the DPHs found in the old health authorities, who had to be medically qualified, this is not the case for PCT DPHs. Some examples of this are Tower Hamlets PCT where the DPH is a health economist, Preston PCT where the DPH is a social scientist and Plymouth PCT where the DPH is a health visitor. There are about 300 PCT DPHs with some 10 per cent being non-medics.

All Party Parliamentary Group report on primary care and public health
Public health will be a key issue in the NHS in 2005. For more on public health and PCTs, see the report from the all-party parliamentary group (APPG) on primary care and public health. This particularly welcomes the multidisciplinary approach being taken by PCTs. The APPG report also discusses extending the public health family to include health visitors, district nurses, school nurses and even specialist nurses in coronary care and diabetes, as well as managed public health networks.

The Wanless reports
Public health has bubbled right up to the surface with the publication of a major White Paper in November 2004 — about taking on the modern four horsemen of the apocalypse, namely obesity, heart disease, diabetes and the cheeseburger... The report, Choosing health, is worth a read.

Previous to that the second Wanless report, Securing good health for the whole population was published, written again for the Treasury and sets out how the UK can achieve the ‘fully engaged’ scenario, mapped out in the earlier Securing our future health. There is a high emphasis placed on avoiding ill health. These developments will shape the public health agenda for the rest of the decade. Also see the joint submission from the Faculty of Public Health, NHS Confederation and the UK Public Health Association which makes a plea for a new role for public health, combining public health networks and acute trust medical directors and PCT DPHs working together on local public health targets. As in the new Wanless report, these people are worried that PCTs might not have the capacity to deliver in this area.

Although with public health increasingly becoming the ‘health of the public’ we still find that many PCT agendas remain essentially determined by the acute sector. The power of the new GMS contract to incentivise primary care public health interventions may not have been fully appreciated by PCTs as yet. For example, several DPHs have commented that the same public health interventions can hit cancer, coronary heart disease, diabetes and so on. And in order to address the wider determinants of health, such as the environment, transport, housing and employment, PCTs have been urged to collaborate more with local government. Some commentators have said that improving the health of the nation cannot be left to the NHS alone and the answer is for PCTs and local authorities to establish joint public health teams. The NHS Alliance considers this whole area now so important that they have appointed Professor Sian Griffiths, former president of the faculty of public health, as network lead for public health.

A key issue for companies is about the possible need to pick up the ‘public health baton’ and get much more involved. Are there alliances and partnerships that can be forged to tackle the growing burden of morbidity? Such alliances could even move beyond disease management into policy partnerships and begin to focus on important public health issues such as health inequalities.