Health promotion

A very valuable report emphasising the opportunities for prevention over treatment. However I would really have like to have seen a chapter dedicated to hihglighting the importance alcohol prevention, integrated of course within the wider Public Health agenda. Primary Care is the key setting for delivering highly cost effective brief interventions to reduce early stage/harardous drinking. Yet as the report acknowledges, many Practices don't have the skills or support to delvier these. The alcohol DES has not been suficiently effective and so further resources and structures to support better delivery of alcohol prevention in Primary Care is needed. Such reports are a key mechanism for achieving this.

Excellent stuff.Two points. I've never really understood the 'giving lifestyle advice may be detrimental to the GP-patient relationship'. We wouldn't find it acceptable if a lawyer was reluctant to discourage a client from behaving illegally in order to keep the relationship intact! Is it that different?
Much of the discussion about the role of GPs and ill health prevention is seen through the prism of giving 'information'. And giving people more information about NHS provision etc is also an important aspect of the White Paper.. Of course it is desirable to give people data that will allow some of them to exercise their choice more effectively. However it is not enough to supply information indiscriminately and without context as people will utilise the information in different ways and in some cases not at all. As we know emotional reactions will be more important than the rational processing of information when it comes to influencing decisions and making choices.The report is right to highlight the need for training and for the development of skills if such interventions are to be effective.

Surely by the time you wait for people to come through their GP's door, it is a little late for much health promotion. It is patronising to believe that people just need more information- that they aren't already aware of how much alcohol they should drink, how they shouldn't smoke, and how they need to do more exercise. The problem is their position in the cycle of change which is often locked by societal factors- cost and time of eating healthily and exercising, stress and emotional distress self-treated with alcohol/smoking/excessive food.
I don't disagree that GPs should expand their health promotion role, but there needs to be wider support from employers, the media, local and central government in order to make a positive impact on how we live.

Prevention is better than cure. But we are still in a society where the later is still evident. The GP is a secondary source for information in most cases as the patient sees them because they have something wrong with them not because they are well and doing.
To prevent you need first hand source.
To prevent you need a better choice.
To prevent you have to take cost factor into play.
To prevent it has to be done at the basic level of society, culture, and so on.

i.e.
pre baby checks -fit to be pregnant -picks up any issues before pregnancy -high blood pressure -which in pregnancy could be risk to mum and babe. Info given on looking after self in pregnancy, expectations and so on.
once pregnant -pre natal checks -info given on post birth -this gives them time to look, do , find out more -at birth they are not fit to take on board.
its just an example but can be done with school children -before things happen.