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Commissioning a patient led NHS - changes in public health arrangements

26 July 2006

Dear Sir/Madam
I am writing to congratulate you on your recent appointment as Director of Public Health for […..] and to extend an offer to work in partnership with you to consolidate and develop the Public Health function in England.

In your role as Director for Public Health you are in a pivotal position with regard to the HR Framework relating to 'Commissioning a Patient Led NHS'. The BMA was involved in the development of this guidance and we believe we will have an important role in its implementation, in particular with regard to the following paragraphs:

10: 'All reasonable steps should be taken to maintain specialist public health capacity and to avoid redundancies… '
11: 'All PCTs are encouraged to make joint DsPH appointments with Local Authorities...', and
14: 'Precise arrangements for joint working between PCTs and LAs will depend on tiers, number and size of LAs in the geographical area covered by the PCT….This might for example include making a joint appointment of a DPH to the Local Authority who will be a deputy director or locality director of the PCT…'

I would encourage you to help ensure that each PCT and Local Authority have the capacity to:
(i) Monitor the health of their population, with the support of the Public Health observatories
(ii) Protect health through maintenance of immunisation and screening programmes, and with capacity to deal with communicable disease outbreaks with the support of the Health Protection Agency, and
(iii) Develop partnerships capable of exploiting opportunities to take action that will address excess mortality in a local area. This capability should include capacity to work with local GPs and consultants in public health medicine.

Since 'Shifting the Balance of Power' the medical qualified leadership of Primary Care Organisations has shifted away from Directors of Public Health. In many cases it has changed to appointed Medical Directors rather than the Professional Executive Committee. I would urge you to ensure there is a proper review of medical leadership within the PCTs in your area and that there is a proper place for Public Health Physicians in that leadership. The knowledge base, analytical skills and objectivity of Public Health Physicians are important in ensuring that short term considerations do not overshadow the long terms health interests of the population and that conflicts of interest are declared and a balanced view taken. Public health Physicians may be regarded by some as an expensive resource. An objective view of their value for money against alternatives within the SHA would be of great value.

The BMA is committed to the development of Public Health roles that are “fit for purpose”, that support an increasingly efficient NHS, capable of delivering high quality patient-centred care. Our aspiration is that new PCT and SHA structures will enable Public Health specialist skills to be well used and developed, in a way that is widely supported and sustainable.

I am sure that you recognise that you have an able, trained and willing workforce within the specialty of Public Health that can demonstrate high added value if organised in the right way and well led. Those DsPH who are displaced in the forthcoming round of PCT mergers have very extensive experience that we should all wish to see put to best use.

Yours sincerely
Dr C Spencer Jones
Chairman, Committee for Public Health Medicine and Community Health