Squaring the circle: Developing public-health competencies in primary care

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Abstract
Recent changes in UK Government health policy mark a shift towards giving greater prominence to public health, especially within primary care. These changes provide broad guidelines for improving public health practice but standards, beyond those for public health medicine specialists, on the competencies or skills needed to deliver the new public health agenda have not been agreed. This paper aims to explore the current policy agenda surrounding public health and primary care in England, and to consider its historical roots and new developments. Within the context of current health policy and practice in England it reviews the frameworks for defining a public health practitioner at primary care level and appraises the competencies and skill-mix required for delivering a public health-oriented programme. Focusing on community nursing, frameworks from other countries are discussed to elaborate a picture of what is needed for the future development of public health nurse specialists. It concludes by suggesting avenues for research and development that will promote the understanding of public health practice in primary care.