Councils are developing coherent, long-term public health strategies

Local authorities can now relate to the Beatles' Ringo Starr when he sang 'How do I feel by the end of the day?' Photograph: Jon Super/AP

Now councils have a major new role in public health, they once again have the chance, as Ringo Starr didn't quite put it, to help their residents feel better at the end of the day.

The report I have written for Localis clearly shows councils exploring new and innovative ways to tackle the wider social, cultural and environmental determinants of health, following April's switch of £2.7bn of public health funding from NHS control to the hands of local authorities. New health and wellbeing boards were created, enhancing the role of councils in the planning and oversight of all local health services.

With NHS acute treatment costs on a seemingly unsustainable, upwards trajectory, this shift in emphasis towards prevention and tackling the "causes of the causes" of poor health could not be more timely.

Housing, transport, children's services, leisure services and employment (among others) have all been demonstrably linked to health outcomes. It is refreshing, then, to see councils showing real innovation in pushing through short-term public health projects with the potential to deliver instant benefits. Barnet borough council told us that this year it has rolled out green gyms, "forging a closer integration between public health and leisure providers".

Alongside such "quick wins", it is inspiring to see councils developing coherent, long-term public health strategies. A mass of evidence links employment to a person's health and wellbeing, and Kent county council's long-running apprenticeships programme offers businesses grants of up to £2,000 to take on an unemployed 18-24 year-old as an apprentice.

Critics argue that the £2.7bn public health budget transferred to local authority could prove a little leaky, accusing councils of using the money to fill in holes in their budgets. But as Public Health England chief executive Duncan Selbie rightly observes, "ultimately these are local decisions".

Selbie is right to caution, however, that this approach should not be taken too far, offering reassurance that if money was spent on things "completely outside any reasonable view about what constitutes health then of course we'd have to be addressing that".

And where existing, traditional public health themes are demonstrably working, councils are continuing to support such measures. Persistent problems like smoking cessation, healthy eating, drugs, alcohol services and sexual health, are – quite rightly – still absorbing the overwhelming majority of public health budgets.

The return of public health responsibilities to the town hall is a golden opportunity to do things differently. But, crucially, restoring public health to the heart of local government requires fostering links and synergies with wider local government functions.

And to do this, councils will need more than a little help from their friends.

Gwilym Tudor Jones is a research fellow at thinktank Localis.

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We need to engage GPs in developing primary care

A distinctive feature of CCGs is that they harness the clinical expertise of their GP members. Photograph: Hongqi Zhang /Alamy

The creation of clinical commissioning groups (CCGs) is at the heart of the government's reforms to health and social care in England. On 1 April 2013, these newly formed, clinically led groups were handed control of around two-thirds of the English NHS budget, and responsibility for commissioning secondary and community care services for their local population. Much attention has been given to their commissioning role, but CCGs have another distinct role to play in supporting quality improvement in general practice. CCGs are in the unique position of being membership organisations, which presents an opportunity for GPs to be more closely involved in transforming primary care.

Will CCGs be able to influence changes needed in primary care when they do not oversee the NHS contracts for primary care? Success here will be dependent on strong engagement with GP members.

The King's Fund and The Nuffield Trust have been working together to study six CCG case study sites, focusing on governance processes and structures as well as emerging relationships. A distinctive feature of CCGs is that they harness the clinical expertise of their GP members. Our research explores how this is being done in practice – how members are involved in their CCGs, what influence they have over commissioning decisions and how leaders and members are working together to develop primary care locally. Findings from the first year of the research reveal the opportunities that CCGs have and challenges they face.

Our research suggests a great deal of enthusiasm at grassroots level, with GPs generally wanting CCGs to succeed, and a lot of energy and enthusiasm among leaders. CCGs have brought local clinicians together, in many cases formalising and building on collaborations between practices that existed more loosely under practice-based commissioning; but in other cases through the creation of new networks and relationships. We heard from GPs who felt positive about being in it together.

More than two-fifths of general practice respondents to our survey felt they could influence the work of their CCG – far higher than the number who thought they could have influenced primary care trusts (PCT) in the past system. Interviews suggested that the GP voice is better represented in CCGs than it was in PCTs.

Importantly, the majority of GPs believed that CCGs have a legitimate role in influencing their members in terms of referrals, prescribing, and other issues – although some felt wary about the form that this involvement could take. There was concern that the financial environment that the NHS is facing, with significant savings needed over the coming years, may lead to CCGs performing a rationing function that could damage GP-patient relationships.

Reconciling this role with the need to maintain clinical engagement and member ownership will therefore be a delicate balance for CCG leaders to strike. Most CCGs are emphasising their intention to take a supportive approach, particularly through provision of comparative performance data to member practices, and by facilitating various forms of peer-to-peer dialogue.

Our survey also highlighted that engagement – awareness, support and involvement – among CCG members is not universal. Nearly half of our survey respondents without a formal role in the CCG feel disengaged in its work – lack of time and capacity being the most frequently cited reasons. CCG members are also less likely than leaders to believe the CCG is owned by its members. Low GP engagement was a major barrier to the success of previous models of clinical commissioning. It is therefore critical that CCGs continue and build momentum on engaging GP members. Driving service changes that will win the support of the clinical community may be important here.

Over the next two years, our case study sites will shed further light on whether and how CCGs are building on the enthusiasm at grassroots level and harnessing the support of their GP members in order to develop and change primary care.

Shilpa Ross is a researcher for the King's Fund and Dr Louise Marshall is specialty registrar of public health for the Nuffield Trust

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