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Boundary issues could hamper public-health plans

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A senior authority on public health has spoken of her fears that the government’s GP commissioning proposals could hamper wider health-improvement goals.

Anna Dixon, director of policy at the King’s Fund, told a debate session organised by the charity that there were risks associated with the scrapping of Primary Care Trusts – which is due to take place from 2013 as part of the government’s health reform proposals.

Dr Dixon said that devolving health commissioning down to GP consortia, at the same time as transferring public health responsibilities to local authorities could introduce territorial barriers as well as expose shortcomings in current healthcare approaches.

She said the “potential mismatch” between GP consortia footprints and local authority boundaries could hamper collaborative working between councils and practices.

“There is a chance it’s going to mean it will be more difficult for the NHS and local authorities to create those partnerships to deliver on public health,” she said.

Dr Dixon added that King’s Fund research had also showed that while GPs focused on patients who presented themselves for treatment, they lacked “a popular view” of the wider local situation that was “the bread and butter of public health”.

She added that there was also a risk that devolving commissioning to GP consortia could also widen health inequalities as the most hard-pressed practices in deprived areas were not necessarily the best resourced practices.

Speaking to  LGC after the event – which also featured public health minister Anne Milton and Lindsey Davies, president of the UK Faculty of Public Health – Dr Dixon said she believed the main issues faced on the boundary issue involved an overload of partners for GPs.

Dr Dixon said having to deal with two directors of public health, two directors of adult social services, and two local plans could lead to “clouding” for GP consortia that would interfere with wider public-health goals.

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