Dr Stephanie Lamb explains how she set up a teen-friendly service in the community aimed at confidentially dealing with sexual or psychological problems.
Our scenario
Between 1999 and 2002, I lived and worked in the small coastal town of Mackay in Queensland. Like in the UK, the Australian health system has plenty of problems, but it does get one thing right – its approach to adolescent health.
When I went to Australia, I didn't think of teenagers as a group with distinct health needs, but I quickly saw the error of this. In a short space of time, I learned just how wary young people were around questions of confidentiality and the need to provide them with support and guidance that was on their terms. Moreover, I saw the importance of young people having a safe space that was their own. They enjoyed coming to the one-stop shop and were happy accessing primary care services.
I returned to England in 2002 to work in Lambeth. At the time, Lambeth had a young population with high rates of teenage pregnancy, STIs and obesity, but despite this there were very few healthcare interventions focused on adolescents in primary care. To address this, I decided to set up a young person's clinic as part of my practice – Herne Hill Group Practice – inspired by models I had seen in Australia.
What we did
The young person's clinic responded to a needs assessment funded by the NHS Lambeth teenage pregnancy team. The research showed that 97% of those questioned wanted a youth-specific service. The fundamentals of the young person's clinic were easy to establish: it was a walk-in clinic operating one afternoon a week for 13 to 19-years-olds, run by the same doctor each week.
We established a clinic wholly funded through our PMS contract. Initially, there was no extra support, but since then – as numbers have increased – we have added a nurse in addition to the doctor. To reassure young people about their confidentiality, the young person's clinic has its own separate entrance and receptionist.
The consulting rooms used are screened off from the rest of the surgery, so it works as an entirely private area not accessible from the main part of the surgery. In this area there are lots of posters and leaflets specific to the needs of young people.
What we found
The clearest sign of the success of the young person's clinic is in the increasing attendance, from an average of five young people coming in each week in 2005, to 13 by 2010. Patient satisfaction is also exceptionally high, with 100% of patients asked saying they would come again and 97% saying they were very or extremely happy with their consultation.
It is difficult to measure the area-wide impact the young person's clinic has had, but our evidence suggests that it has been particularly effective in early detection of mental health disorders, with 24% of young people presenting with psychological conditions.
Expanding the concept
I decided to build upon the success of the young person's clinic by developing a new adolescent health service in the community.
The Streatham Well Centre, which opened last month, takes healthcare to young people. Crucial to this has been a partnership with John Poyton, director of Redthread, a local youth charity.
Together John and I had a shared belief that healthcare services should be doing more to engage young people, and that the model of care used needed to be sensitive to the needs of the adolescent.
As we began to scope out the possibility of a community health hub for young people, we also started to develop a new model of adolescent care – a model that provided young people with a more holistic and enriching experience that combined the best of both youth workers and GPs.
The Well Centre is a youth health centre for young people aged 13 to 19 open on a Monday, Wednesday and Thursday from 3-6pm. It was developed initially via a partnership between Herne Hill Group Practice and Redthread, aimed at ‘improving adolescent access to primary care'.
The outcome of this work was a recommendation for a youth one-stop shop. We received funding through the NHS London Innovation Fund, and matched funding from Guys and St Thomas's Charitable Trust, The South London and Maudsley Charitable Trust and Lambeth Council. In total, £500,000 in funding was awarded for an 18-month pilot, after which we will seek to be commissioned via the local clinical commissioning group.
The centre is based on a robust approach to confidentiality. We assure users that anything they discuss with any member of the Well Centre staff – doctor, nurse or youth worker – will stay confidential within the team. Even if they are under 16 nothing will usually be said to anyone including parents, other family members, care workers or tutors without their permission. The exceptions to this are:
- if a young person says we can tell other people
- if we suspect a young person is being abused or is in danger, we can tell appropriate professionals – but we will discuss that with the young person at the time of their consultation
- if a young person is being treated elsewhere they are encouraged to let the doctor or nurse inform the other practice of any treatment they are receiving from us, but permission is asked to do this.
Getting the Well Centre off the ground wasn't always easy, but we now are proudly housed in a purpose-built, youth-friendly space that backs onto an existing youth centre. We've succeeded – I hope – in creating an informal and welcoming space that young people will be happy to visit, and will encourage more young people to access healthcare.
The model that we've developed here is not fixed -- it will change and be adapted to different contexts – but the underlying principle is.
Everyone needs to recognise the specific healthcare needs of teenagers and everyone needs to work hard at addressing these more effectively.
Dr Stephanie Lamb is a GP in Lambeth and co-founder of the Well Centre www.thewellcentre.org
