Public health governance and primary care delivery : a triangulated study

Abstract

The government is committed to improving health and well-being and tackling health inequalities. PCTs and other commissioners are charged with maximising health improvement for their local populations, working in partnership. However, the effectiveness of a local public health system in addressing these tasks is influenced by how far PCTs and other commissioners prioritise public health in the context of a complex web of incentives and governance arrangements, some of which may conflict. In contrast with other forms of governance, such as clinical governance, the concept of public health governance and what counts as success or failure in this respect is poorly developed. The first part of this study will scope dimensions of public health governance and map incentives and governance arrangements for health improvement at national level. We will choose ten PCTs for detailed study, exploring the impact of financial (and other) incentives and governance arrangements on commissioning priorities and on the health improvement activities of practices, using a combination of interviews and documentary analysis. Views over how best to achieve public involvement and accountability in relation to effective stewardship of public health will be explored through interviews in our case study sites. We will supplement our local case studies with a national survey of key stakeholders in PCTs and two focus groups, one at national and the other at regional level. The research will be of benefit in identifying incentives (and barriers) to prioritising investment in health and well-being and in clarifying the role of the public in public health governance.