The health needs of your local population

Understanding local health needs is the responsibility of the PCT. This knowledge should significantly influence many of the basic assumptions about a community's health needs before any detailed premises work is undertaken.

For many years, health planners and public health doctors have tried to examine the health needs of the population, and this has always been a central feature of community nursing practice. Individual needs assessment is part of the GP's role. With the advent of PCTs this has been extended to community level. PCTs are responsible for purchasing services to meet the health needs of their population. A health needs assessment exercise can help target limited resources more effectively and efficiently.

There are three separate but linked approaches to health needs assessment (see 'Moving Forward: Needs, Services and Contracts' for more details):

The epidemiological approach, which defines healthcare need as 'the ability to benefit from healthcare' and is based on information about incidence, prevalence and the effectiveness of treatments, including cost effectiveness.

The comparative approach, which contrasts the services received by a population in one area with those received elsewhere, and is based on information about utilisation rates, service performance and cost.

The corporate approach, which involves the structured collection of information on healthcare services and needs from a range of stakeholders, including healthcare professionals, patients and the wider public. All these approaches can be used at PCT level but a combination of different elements from each approach is often most effective. In the context of a local strategic plan, the corporate approach is normally the most appropriate. In a PCT-based (or locality-based) health needs assessment the focus is on the individual PCT's population (or groups within it) and is undertaken from the perspective of the primary and community healthcare team. PCT-based assessments are usually targeted at one of three levels, as follows.

1. Generic or population level assessments examine the overall health needs of a whole PCT population or a community served by a PCT. They are often used to identify key areas of health needs, and may identify the need for more detailed health needs assessments. Key areas of health needs may be defined in a number of ways, including:

• the prevalence or incidence of a health problem
• the number of consultations or contacts associated with that problem
• the most common reason for referral to secondary care
• the frequency and cost of procedures
• the health problems perceived to be of most importance by patients, the local community or local primary care teams

2. Client group specific assessments examine the health needs of a specific group within a PCT population, for example adults with mental health problems or older people. They are often used where a PCT already has an indication that the health needs of a particular group are not being met effectively. This type of assessment is often undertaken where:

• local mental health services are poor
• one group accounts for a large proportion of a PCT's population, for example older people
• one group appears to be using a disproportionate level of a PCT's resources, for example drug misusers

3. Disease or intervention specific assessments examine the level of patients with a particular disease or condition, for example those suffering from asthma or experiencing chronic low back pain. They can also be used to assess the need (or demand) for a particular intervention or procedure, for example the number of referrals for coronary artery bypass grafts or termination of pregnancy, or the number of patients receiving hormone-replacement therapy. With this type of assessment it is important to remember that consultation, referral and prescribing rates do not equal need. For a number of reasons some patients, who could benefit from an intervention, may not consult their GP. Also, referral and prescribing rates could be affected by the GP's own knowledge of the disease area or the availability of the service. It is also important to compare PCT information with information from other sources, for example national prevalence and incidence figures, referral rates in comparable PCTs or guidance on clinical effectiveness. This type of assessment can be valuable if a PCT wishes to examine how well it is meeting the needs of patients with a specific disease, either from the patient's perspective or in terms of clinical effectiveness. In order to decide the type of health needs information that is most relevant to your SSDP (in other words, whether to focus on a population, client group or disease area), you will need to:

• build on local knowledge and interest
• consider any current or previous work by the PCT (perhaps by individual GP practices) or SHA
• clarify the reasons for undertaking the health needs assessment
• assess the time and resources that you have available

Once you have decided on the type of health needs assessment, the main steps for carrying out the assessment as part of a local strategic plan are:

1. Establish your health needs assessment team
2. Assess the time and resources you can commit to the assessment
3. Decide what information you need
4. Decide how you to research the information
5. Collect the information
6. Analyse and review the information
7. Confirm your priorities for change
8. Add this information to your local strategic plan

A key document for gaining a detailed understanding of health needs assessment is 'Health care needs assessment - the epidemiologically based needs assessment reviews'. LDPs/SDDPs also contain useful health needs information.