Editor's blog: Councils at the heart of healthcare

For the first time in more than 60 years councils are to get their hands on the health service. But to make local accountability of the NHS a reality they need a more radical health bill and managers who can work with an alien culture. The stalled health and social care bill promises to reduce central government control over the NHS while handing more power to family doctors and councils. Local government will be responsible for public health, it will continue to scrutinise local health bodies such as hospital trusts and, crucially, it will influence GPs in their new role as commissioners of health services. But wresting power from such a notoriously centralised body as the NHS will take more than the spineless reforms on offer. As the bill stands, local GP consortia only need to "have regard to" the views of the new council health and wellbeing boards, which is different from having to take much notice. The boards, meanwhile, will be able to scrutinise commissioning plans to see if they comply with their own health and wellbeing strategy, but will have little power to ensure the consortia take action if the plans are found wanting, beyond having a formal whinge to the national NHS commissioning board overseeing the consortia. The Local Government Association is pushing the government to toughen up the bill to match the coalition's localist rhetoric. It wants GP commissioning consortia to "consult and co-operate" with health and wellbeing boards, and boards to sign off local commissioning plans before they are sent to the national commissioning board. In the coalition the Lib Dems are pushing for the boards to have a councillor majority. At present, each includes at least one councillor, the local authority's directors of adult social services, children's services and public health, a representative of the local HealthWatch patient group and commissioning consortia representation. But even with more localist legislation there are numerous obstacles to local government influencing health plans. Managers will need to cross a cultural chasm to build relations with GPs. Doctors go into general practice because they love working alone, hate being managed. Since they also make life-and-death decisions in an average of about nine minutes they have the attention span of a gnat. An hour-long presentation on your local vision may not be their idea of a productive morning. Crucially, they will struggle to understand why local politics should matter to the NHS. GPs focus on the patients on their list; councils, of course, address the needs of the entire community. And with their new – albeit poorly defined – public health role, councils might often take a broader perspective of health needs. The way for local government to win the hearts of GPs is to demonstrate the unrivalled access and insights that councils bring. Councils can identify communities with unmet health needs, whether it be Bangladeshi families with untreated diabetes or teenagers needing sex advice. They can reduce accident and emergency admissions – whether by stepping up work with local bars and police to cut Friday night violence or raising awareness of stroke risks. And councils are uniquely placed to identify links between ill health and housing. Above all, health and wellbeing boards will ratchet up integration of health and social care. With both the NHS and councils struggling with budget cuts, a relentless focus on early intervention can save both sides money by keeping more elderly people out of hospital and living in their own homes. The big opportunity for councils is not Eric Pickles' oversold new dawn of "guided localism", it's putting councils at the heart of local health services. Richard Vize is contributing editor of the Guardian local government network This content is brought to you by Guardian Professional. Join the local government network for more like this direct to your inbox.