Population health

Purpose and context

Good health is vital for the prosperity of the communities we live in. Improvements in life expectancy stalled in the decade before the COVID-19 pandemic due to wide inequalities in health within and between local areas in England (Institute of Health Equity / Marmot, 2020).

Population health is an approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people, while reducing health inequalities within and across a defined population. It includes action to reduce the occurrence of ill health and to address wider determinants of health, and requires working with communities and partner agencies.

Population health continues to evolve as technology develops. The era of big data has helped establish a subdivision of population health: population health management. Narrower in approach and with a focus on using data to analyse and interact with specific populations, population health management will become more prominent as the health industry becomes more data rich. The International Data Corporation predicts that the global ‘data sphere’ will increase from 33 to 175 zettabytes from 2018 to 2025, with healthcare among the fastest growing sectors because of advancements in healthcare analytics (Reinsel, et al., 2018).

The population-level approach to reducing health inequalities will be a cornerstone of new ways of working through ICBs. Health staff need to feel confident in their skills and abilities to carry out their duties through existing roles, new roles and transformed services, to most effectively meet the health needs of their population. Ensuring we have an integrated approach across health and social care will support the workforce to contribute to the system.

Primary care networks have a role in addressing and improving the health priorities within their communities. In this way, GPs contribute to population health through their interaction with individual patients and their engagement with the PCNs and ICBs in which they work.

The importance of understanding population health was highlighted during the COVID-19 pandemic, when the social determinants of health led to the disproportionate effect of the pandemic on certain groups. Higher rates of mortality in areas of deprivation and the effects of the societal response to the pandemic focused our attention on the health and wellbeing of the population.

We need to enable healthcare staff to collaborate and co-produce with the local population to deliver improved health and wellbeing outcomes (Delgado, et al., 2021).

We heard...

GP DiTs are aware of health inequalities, the importance of preventative health approaches and the challenges of health access for specific groups of the population.

GP DiTs gain awareness of population health through ITPs in community specialities, public health, ICB placements, and their clinical GP placements. Discussions with the multiprofessional team, such as social prescribers, also enhance their knowledge, and some areas have very specific services, such as a healthcare bus for the homeless and sex workers.

GP DiTs form the biggest professional group in the National Population Health Fellowship, which is a multiprofessional programme that places professionals in population health placements focused on health inequalities.

Priorities and action

GP DiTs need to be exposed to placements, learning opportunities and educational events about population health. By promoting this learning, we can ensure our future clinicians understand how to articulate and influence health provision for local populations and tackle health inequalities.

We propose the following initiatives:

• promotion of educational resources about population health, including mandatory adult and child safeguarding;
• peer learning from different health settings meeting local population needs, especially for the GP DiTs involved in the HEFT programmes;
• increasing and varied innovative ITP posts in public health, ICBs, community specialities and prisons, and signposting to third sector services such as shelters for the homeless;
• more GP DiTs doing the National Population Health Fellowship;
• engagement in PCN responsibilities, such as impact and investment-funded activities and carrying out quality-improvement projects;
• experience of clinical leadership and workforce transformation addressing population health within ICBs or PCNs;
• promotion of the importance of health improvement activity, such as management of hypertension and secondary prevention of cardiovascular disease.

It is recognised that a dual Certificate of Completion (CCT) for general practice and public health would be valuable. GPs are responsible for the health of their communities, and those who have gained advanced public health skills through a CCT in public health can offer more when it comes to population health. This is particularly important for GPs involved with integrated services (such as PCNs) that serve large populations.

Historically, GPs with a CCT in public health usually completed their GP training and public health training separately. However, the Medical Act freedoms following the UK’s exit from the European Union allow for a training programme that delivers a dual CCT in GP and public health, with both the RCGP and the Faculty of Public Health (FPH) being supportive.

The mapping of the RCGP and curricula demonstrates that there is sufficient overlap to meet the GMC requirement that dual CCT programmes must reduce training time by at least one year. As such, HEE is collaborating with the RCGP and FPH to launch a dual CCT in general practice and public health.