Reducing Health Inequalities is central to Public Health and Population Health. Contemporary healthcare is increasingly focused on optimising patient care and outcomes at the population level. Public Health and individualised healthcare are essential partners rather than concepts in conflict. Public Health applies a broader and proactive view than traditional health care by extending the 1:1 individual approach to a targeted cohort of people (e.g. specific medical condition, community, age-group, etc.). It also adds the delivery of interventions such as public health, risk factor modification, health promotion and community engagement within the interaction of a patient and a healthcare professional.
Public and Population Health considers the determinants of health that fall beyond the immediate reach of the healthcare setting such as social circumstances, environmental exposures and behaviours. Chronic medical conditions such as obesity, diabetes mellitus and cardiovascular disease are suited to a population level approach.
Professor Maggie Rae PrFPH, FRSPH, FRCP(Hon), FRCP Edin, FRCPath (Hon)
Sout West Health Education England (HEE) agreed to support the development of Primary Care Training Hub (PCTH) Fellowships. In the initial phase 1 development,7 Fellowships were developed 1 to each ICS/STP area in the South West. Successful applicants embark on a year-long part-time fellowship, typically 1 day a week, alongside their permanent post.
Public Health supervision is provided by a Public Health EducationalSupervisor and line management from the training hub.
The approach to the assessment of the learning outcomes is formative (via written reports and presentations). In addition to Public Health competences there is also a strong focus on leadership and management development.
The aim is to enhance Primary Care’s contribution to Public Health and Population Health. Also, to recruit Fellows with potential and help develop the contribution they can make to local place-basedsystems and improve patient and population outcomes.This should include a reduction in Health Inequalities.
As part of the Programme each Fellow will produce a case study on the work they have undertaken as a Fellow.
We are very delighted to present this series of case studies produced by Fellows in the first cohort of the programme and give thanks to the Public Health Supervisors and Primary Care Training Hub leads who support the programme.
~Professor Maggie Rae, Head of School of Public Health and Transformation
~Dr Lizzie Eley, Primary Care Dean
Please see the case studies from Cohort 1 - please note that more will be added as Fellows complete the programme.
I am an NHS GP and spent 12 months doing a Population Health Management fellowship, supported by the primary care training hub and public health colleagues. I had noticed that the uptake to the Bowel Cancer Screening Programme was significantly lower than other large scale screening programs such as cervical cancer, and one of my initial thoughts was that this may be related to the lack of primary care involvement in bowel screening (in contrast to cervical). Looking into it further, I found that uptake is also socially graded and that men have significantly worse uptake than women, with this having the potential to worsen health inequalities.
Together with my mentor I developed an intervention based on existing evidence on improving uptake to screening, which demonstrates that GP endorsement can boost uptake significantly. Combining this with elements of behavioural economics/nudge theory, we designed a text message which could be timed with the receipt of the screening kits, encouraging patients to take up screening. We segmented the target population by looking at screening history, which has been shown to be a very strong predictor of future uptake and targeting those at higher risk of non-uptake.
Over 6 months at two different GP practices, we were able to significantly improve uptake to bowel cancer screening; compared with pre-intervention control groups, we saw uptake increase from 47% to 69% at one practice, and from 65% to 77% at the other. I have been able to present the work in local primary care forums such as the CCG and my PCN and hope that the intervention can be rolled out to more practices in our locality and beyond.