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At the heart of general practice since 1960

Pictures of the future of practice

Dr Olive Buckley explains how she gives clinical advice to teenagers using their favourite accessory – a mobile phone

Dr Olive Buckley: to the teens she is not Dr Buckley but Oli B

Our practice is in a large seaside town within commuting distance of Belfast. Like most other large towns in Northern Ireland it has had its fair share of paramilitary intimidation and violence.

The practice population is of mixed social class. I am one of five partners in a practice of 7,700 patients, and around 1,000 of those are aged between 15 and 25.

What we were up against

Like all young people our teenage patients are at risk of unplanned teenage pregnancy, drug misuse, mental health problems, sexual abuse and, of course, the ever-ticking sexually transmitted disease timebomb. Young men in Northern Ireland suffer the highest suicide rates in Europe.

In these fast-changing times, young

people are distanced from the traditional medical model of the GP surgery and health professionals are failing to connect with them because they do not attend the

practice.

What we did

We recognised the difficulty this group

have in not only accessing appointments

but also in communicating when they get there.

Historically, the silent unhappy teenager, dragged in by the distraught ‘rent' (text slang for parent!), has grunted only in response, avoiding eye contact, gazing longingly at their mobile phone, no doubt wishing the consultation was over so they could get back to their mates and to every teenager's favourite form of communication, mainly text or MSN.

With the introduction of the practice SMS Teen-Text line, coupled with the reassurance of a confidential, non-judgmental service, this same group have become fluent communicators with the practice.

Operation Teen

Following a text request for advice an appointment is offered promptly, usually for the same or following day. Flexibility of appointment time is often crucial. A store-room, which was previously used as the practice dumping ground, has been transformed into a ‘caring room' by a local interior designer. Many questioned the designer's wisdom, arguing that teenagers would have felt more at home in the room in its original state!

On arrival, if the teens wish to avoid the inquiring eyes of the public, they wait in the ‘caring room'. It also provides a safe haven if they are upset or need to wait for results, and can provide somewhere for their parents or their friends to wait. Those who do not consent to being seen are encouraged to have a consultation by telephone or, if known to be Fraser competent, by text.

Could you do it?

Although we had funding from the East Antrim Local Health and Social Care Group, it's really easy and it's cheap! The software package from Nokia (PC suite version 6.6, www.nokia.com/nokia/0,,72014,00.html) costs £90 including the phone. Currently I respond to the texts.

This is caution on my part – as it is a new service I want to be the first to know about any problems that may arise. Our nurse is currently being trained, and it's also hoped to bring the midwives on board with a similar system for the pregnant teenagers.

It's not time-consuming. In a practice with 1,000 young people, I get an average of one text a day. It does not require hours on the phone advising them – their mates do that.

It's simply a matter of allowing them to access medical care when they need it. It's important, hard as it is, never to look shock-ed and to connect as a caring adult. To the teens, I am not Dr Buckley but Oli B.

Staff training

The practice has developed a specialist

interest clerical officer [SICO] in sexual health. Her training included time spent in the genito-urinary clinic and accompanying our nurse on relevant training courses. She is the friendly face to ‘meet and greet' the teenager and has a designated telephone number that teens can contact if they have difficulties with appointments or need to be seen again.

All other staff have had appropriate training in issues surrounding sexual health and young people, ensuring a non-judgmental and welcoming service.

Who texts and why?

Most problems are related to sexual health advice, including sexual abuse, fear of pregnancy, and relationship difficulties. Parents sometimes initiate the contact.

Other problems range from drug misuse to acne to young mums struggling to

cope. Vulnerable adults and those with

hearing problems also make use of this

service.

We have on average two to three new contact texts per week. The number of follow-up texts varies but is never more than five in a week.

Results

As the text service has only been active for nine months, it is too early to say if we have impacted on the pregnancy rates.

As for the impact on the incidence of sexually transmitted diseases and drug- and alcohol-related problems, the teens were not attending our practice in the first place so there is no baseline to compare with. But I do believe we have connected.

Every text is an opportunity to connect and impact and hopefully to steer them away from multiple risk behaviours.

Olive Buckley is a GP in Carrickfergus,

County Antrim

Problems WE HAVE overcOme

• Promotion

The service was promoted in the local newspapers and schools. But it was the teenage jungle drums that really spread the word.

• Data capture

To ensure a permanent and secure record was kept, a software package was needed to transfer messages received and sent. This also enabled me to text directly from my PCs.

• Identity of caller

Due to difficulty in assessing the Fraser competence of the person by text, the outcome of first-contact text was usually either fast-tracking of an appointment or signposting to another agency. The teenager is given a choice of follow-up consultations – either to come again or review by phone call or text. Most choose follow-up by text.

• The ‘Lingo'

A local group of teenagers formatted a dictionary of text jargon and provided in-house training in the language of teens. We quickly learned that the use of words like ‘trendy' and ‘cool' have not been around since the late 1990s and are guaranteed to make teenagers disappear.

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