Health and Wellbeing Boards for a new public health
General practice has always had a population re-sponsibility(theregisteredlist)aswellasaresponsibility to individual patients. These twin responsibilities lieat the heart of what it means to be ‘family andcommunity-oriented’ – concerned not only withtreating the diseases that a patient has, but also recog-nising the impact of their social context – family relationships, jobs, crime and so on. Indeed, this isone of the main reasons why decentralised generalisthealthcare systems are more eﬀective than centralisedspecialist-led systems. In the words of Berwick, ‘(gen-eral practice/primary care) is the soul of a proper,community oriented, health-preserving care system.’
In the words of Starﬁeld, ‘The well known butunderappreciated secret of the value of primary careis its person and population, rather than disease,focus’.
Clinical Commissioning Groups (CCGs) now havetheir hands on the reins of the NHS. This presents anopportunity to meaningfullyspan the generalpracticeroleofpersonalcareandpublichealthincollaborationwith their local authorities through HWBs. Generalmedical practices are statutory members of CCGs andhave to work together to achieve the aims of CCGs toreduce costs and retain quality. As has been describedin recent papers in
, it is becoming increasingly common for clusters of 10–20 practices who servepopulations of about 50 000 to come together todevelop collaborative practice – to share the load of overwhelming demands, for mutual support and forimproved care. Diﬀerent places have called themdiﬀerent things – ‘Local Health Communities’, ‘HealthNetworks’, ‘Cells’ and ‘Hubs’.Thesenewclustersofgeneralpracticecouldprovideasharedspaceforcollaborationbetweenpublichealthand primary care. In these spaces, multiple agenciescouldworktogethertoprovideinourcitiesandtownswhat pioneers like Julian Tudor Hart in South Wales
achieved in small communities – improving wholecommunitycapacity andresilience,aswellaspersonalmedical care. They could translate to the 21st century the vision of Kark’s ‘community-oriented primary care’
and Ashton’s ‘New Public Health’.
HWBs could make this happen, by ensuring thatgeneral practice and community services plan and actin concert with public health, local authorities, schools,voluntary groups and many other organisations, tosynchronise their eﬀorts for health improvement. Con-ventional individually focused approaches to healthpromotion(e.g.smokingcessation,healthyeatingandphysical activity) could be complemented with socialapproaches that harness the energy in communities(termed ‘asset-based community development’).
Thisapproach helps people to help themselves – moreeﬀective than imposed solutions. As Kretzmann says,‘healthy communities have never been built upon theirdeﬁciencies but have always depended upon mobil-ising the capacities and assets of people and place’.
Itmeansrecognisingthathealth ismore than the sumof theirmedicaldiseases,andincludesasenseofcoherencethat Antonovski calls salutogenesis
and MacIntyrecalls Narrative Unity.
In this paper, we revisit the evidence that a socialapproach to health improvement is eﬀective at im-proving health and that it is cost-eﬀective. From this,we suggest what HWBs can do to shape a winningcourse.
A community-developmentapproach improves health
Community development builds conﬁdence to actfor health improvements. For example, community-
The role of Health and Wellbeing Boards
Each top tier and unitary authority will have its own Health and Wellbeing Board. Board members willcollaborate to understand their local community’s needs, agree priorities and encourage commissioners towork in a more joined up way.
Health and Wellbeing Boards will have strategic inﬂuence over commissioning decisions across health,public health and social care, integrating services.
Boards will involve democratically elected representatives and patient representatives in commissioningdecisions alongside commissioners across health and social care.
Boardswillbringtogetherclinicalcommissioninggroupsandcouncilstodevelopasharedunderstandingof the health and wellbeing needs of the community.ThroughundertakingtheJointStrategicNeedsAssessment(JSNA),theboardwilldrivelocalcommissioningof healthcare, social care and public health, bringing in other services such as housing and educationprovision.healthandcare.dh.gov.uk/hwb-guide/