Royal College of Physicians launches new principles for an integrated public health system

The Royal College of Physicians (RCP) has unveiled a new set of principles aimed at strengthening and integrating the UK's public health system. Developed in collaboration with leading health organisations and think tanks, these principles provide a roadmap for more effective, cohesive, and equitable public health.

Public health plays a critical role in improving population health and wellbeing, preventing illness, and ensuring the effectiveness and efficiency of health services. However, years of structural changes, funding challenges, and workforce shortages have contributed to a fragmented system that struggles to meet the needs of communities. The RCP's new principles set out a vision for well-functioning public health that is integrated, well-led, collaborative, and sufficiently funded.

The principles were developed following research and engagement throughout 2024, including a roundtable discussion in November that brought together representatives from the Faculty of Public Health, the Association of Directors of Public Health, the Royal Society of Public Health, NHS Confederation, NHS Providers, the Health Foundation, and the King's Fund, where several key themes to prioritise were identified including leadership, relationships, roles and accountability, and workforce.

The eight principles set out by the RCP emphasise embedding public health across all levels of governance, with strong leadership, collaboration, and accountability. They also highlight the importance of valuing and supporting public health professionals, ensuring they can work seamlessly across sectors, including the NHS, local government, and community organisations. Strategic workforce planning should provide diverse career pathways, training, and equitable opportunities. The RCP is calling for a sustainable funding settlement to improve population health and reduce inequalities, supported by evidence-based decision-making that is aligned with shared public health goals and responsive to community needs.

Commenting on the new principles, Dr Chris Packham, Royal College of Physicians' special adviser on population health, said: “Public health is fundamental to tackling health inequalities. It is the science and art of preventing disease, prolonging life, and promoting health through the organised efforts of society. Organising those efforts require us to take account of the health and care needs of the populations we serve, and central to that is strong and careful integrated public health leadership. Our principles provide a basis for policymakers and stakeholders to work towards a more integrated, effective system.”

The RCP calls on national and local governments, NHS England, Integrated Care Systems, and health providers to take immediate steps to align with and embed these principles. The upcoming government 10-year plan for health presents a crucial opportunity to reaffirm public health as a national priority.

Comments from experts and stakeholders

Saffron Cordery, interim chief executive of NHS Providers, said: “A strong public health system is vital if the government is to succeed in its ambition to reduce health inequalities and achieve a significant shift to preventing ill health.

“NHS trust leaders are committed to working with health and care partners to meet the needs of local communities – but to deliver the public health system people want and deserve we need more investment in and support for the public health workforce.”

Professor Kevin Fenton, president of the Faculty of Public Health, said: “This new guidance, developed by cross-sector health organisations provides practical principles for a well-functioning, integrated public health system.

As the new Government outlines ambitions to shift towards preventative healthcare and deliver on its 10-year plan for health, the principles outlined in our guidance offer a clear route to deliver an effective, integrated approach to public health.

Many of these principles have also been identified during the ongoing COVID-19 independent inquiry, and the Faculty of Public Health and our members stand ready to work with the Government and other stakeholders at local, regional, and national level to implement these principles and support better health for all.”

Helen Atkinson, co-lead of the Association of Directors of Public Health policy advisory group on the NHS, integrated care systems, and social care, and director of public health for Portsmouth City Council, said: “These steps set out by the Royal College of Physicians provide an excellent summary of what is needed for public health teams and their partners to bring about effective, long-term improvements to the places where we live, work and play to enable everyone to live healthier lives for longer. Directors of Public Health are the local leaders and as such play an instrumental role in implementing measures and services that bring together a range of stakeholders to help reduce health inequalities.”

William Roberts, chief executive of the Royal Society of Public Health, said: "We welcome the principles for an integrated public health system and urge the Government to embed them into their upcoming 10-year plan.

Public health is crucial to ensuring the health and wellbeing of the population. It must be prioritised if we want to see a shift in health outcomes and a reduction in health inequalities.

The public health workforce is key to ensuring this change. If they are to respond to the changing needs of the world around us, they must be supported with proper training and access to career pathways."

Adam Briggs, senior policy fellow at the Health Foundation, said: “The new government has made prevention a core part of its health mission. Crucial to success is a public health system that is fit for purpose. These principles set out what that public health system could look like to deliver the long-term shift to prevention needed and to help embed public health across government.”