Prevention in the 2020s – where is primary care?

The 2020s will be the decade of ‘proactive, predictive, and personalised prevention’ , according to the UK Government’s recent green paper on preventing ill health.1 The 78-page report describes a large range of initiatives to be implemented in the coming decade in England, including a ‘portfolio of new innovative projects’ , an evidence-based review of NHS Health Checks, a new National Genomics Healthcare Strategy, a ban on selling energy drinks to under-16s, and new strategies using ‘intelligent’ technology-driven screening programmes to prevent sexually transmitted infections and to increase uptake of vaccination. It also sets a target for England to be smoke free by 2030 and promises a new ‘Composite Health Index’ , as recommended by the Chief Medical Officer for England in her 2018 annual report, to track the nation’s wellbeing and assess the health impacts of wider government policies.2 Many of these proposals are welcome — technology certainly has a key role to play in the future of health care, as outlined previously in the BJGP 3,4 — but the report has not been without its critics. In particular, it has been widely criticised for lacking action and ambition on food and obesity, and has no mention of a minimum price for a unit of alcohol.5 We believe it is also weakened …