Interview: Chris Packham
Dr Chris Packham, is an associate medical director at Nottinghamshire Healthcare NHS Foundation Trust, practising inner-city GP and former director of public health in Nottingham. He has a special interest in designing and prioritising health and care pathways, supporting clinical involvement at a local level to improve population health and reducing health inequalities. He speaks to Commentary editor Bethan Roberts about his new role as RCP special adviser on population health.
This is an online version of a feature initially published in the April edition of Commentary. You can read the full version there, and let us know your thoughts on this new format by emailing commentary@rcp.ac.uk.
Could you tell me about how you became interested in population health?
I started as a GP principal in a mining town in Nottinghamshire and did that for about 5 years. But it became quite clear that what I could offer, in terms of health improvement, was fairly limited compared with the overwhelming influence of all the other things that were affecting people’s health. I carried on as a GP, but I trained up in public health. Since then, I’ve had a dual career in public health and general practice – I’m still an inner-city GP in Nottingham, but I’ve also had a wide-ranging career in public health. I was director of public health in Nottingham for 10 years. Then I moved to a provider trust, where I’ve been a GP and consultant public health physician for the past 15 years. There I play a leadership role in physical health, public health and health inequalities.
You’ve just become the RCP special adviser on population health. Can you tell us a bit about the role?
I will play a part in providing population health advice to the RCP – both individually and working with senior officers in that role. I will chair the Health Inequalities Advisory Group, which I have already sat on for some years. And I represent, as required, the RCP at various meetings and groups. I’ll be working with the RCP senior officers, other special advisers and advisory group members on policy development in this area, particularly around health inequalities.
What areas of RCP work on population health really stand out for you?
The work that it’s done on the Inequalities in Health Alliance (IHA) is a key one. We are harnessing a number of organisations to [approach] the government to tell them that the health service can do its bit in improving health, but wider determinants – which account for 80-90% of people’s health experience – need to be acted on. That can only really be done in a way that is much wider than the health service.
This needs to happen at a local level, so that local authorities and agencies are involved, but also nationally. We need to have joined-up government on this.
Local directors of public health have a saying: ‘Health in all policies.’ They apply that to local council policies. We need to do the same at national government level, so that it has a much larger reach, across the whole of the population.
The RCP has led the IHA very successfully, I think, and there is the promise of a number of developments [emerging from] that which look as if they will be able to make an additional difference.
What do you think are the main challenges that you encounter in population health at the moment?
I think the biggest challenge on tackling health inequalities is the limited [visible] effects [of changes]. The bulk of health experiences that individuals, communities and high-risk groups suffer is outside of the health services’ direct control. We need somehow to harness all the agencies and all the approaches that society has, to try and change things for the better – particularly in relation to health inequalities which, if anything, are worsening as time goes on.
The effect that the health service has is important, even if it is not the primary driver of poor health. The 10–20% of health that healthcare positively influences is particularly important because such change can often be quite rapid. Whereas upstream changes / improvements to the wider determinants of health often take a lot longer [to see clearly] – sometimes generations.
In December 2024, the RCP published a guidance document foron how to tackle health inequalities in their work. What are the next steps that you’d like to see physicians taking?
It’s called Bridging the gap: a guide to making health inequalities a strategic priority for NHS leadersand it’s an excellent document. It sets out not just the case for why health inequalities are important for clinicians, but also some of the things that clinicians can do at a local level.
The opportunities for physicians to input into decisions that are made at local level, in cities and counties, is a bit patchy. It would be good to see greater systematic opportunities for expert clinicians to input into the design and prioritisation of care pathways; how that works with general practice and also how that works with upstream public health and the wider determinants of health.
[In the last 15 years] quite a lot of the technical public health was taken away from the NHS at local level. We need to support better working together of GPs, physicians, public health specialists and others who plan and fund health services, so that we are designing a service that has the greatest impact on people’s health. Currently that is not happening routinely across the whole country.
The other thing I think that physicians can do is influence hospital policy and practices that help reduce health inequalities. Hospitals are very large enterprises and the hospital itself through its procurement, the way it employs staff, its policies and other things that affect wider determinants can play a really big part.
There are some excellent examples where hospitals have done that; empowering people to access services when they have difficulty travelling to the hospital, minimum wage employment practices or employing people from more vulnerable groups. Physicians have got a role in supporting their hospitals in doing things that begin to influence the wider determinants of health.
What’s the RCP’s role in improving population health?
It’s multifaceted. There’s the role in the wider determinants of health that the IHA encapsulates really well. The RCP has a lot of internationally renowned experts and it’s very important that we support and facilitate them.
There is a role in the education – both of established clinicians and of resident doctors. The education material that we have goes a long way towards that. The RCP has recently developed really excellent e-learning modules. It’s a really good starting point, as a briefing, if individual clinicians are interested in getting involved…
I think the RCP’s role is to also look at the NHS and ask what other forums, opportunities or processes could improve physicians’ inputs into a well-designed health service at a local level.
The RCP’s Health Inequalities Advisory Group under Professor Carol Brayne has done a wonderful job in preparing the ground for the next few years, but we’ve got our work cut out to take that forward.
One of the things that the RCP needs to do is open up the opportunities for feedback from our members and fellows – is there anything we’ve missed? Are there any other aspects of public health that physicians see in their daily lives and working practice that could do with attention, that the RCP could help with? We will be developing more opportunities to do that in the coming months.
You can read more about the RCP’s public health work in our article on principles for a well-functioning, integrated public health system in this edition of Commentary. If you have any feedback on this work, please get in touch at policy@rcp.ac.uk.