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Health visitor caseload above Lord Laming levels

By Lilian Anekwe

Exclusive: Primary care organisations are providing fewer health visitors to work in general practice, but their caseload is almost universally higher than advised in the post-Baby Peter review of childcare.

A Pulse investigation, instigated by our guest editor competition winner Dr Georgina Brown, shows the number of whole time equivalent health visitors employed by UK primary care organisations has fallen by 7% in just three years.

And as a consequence of the fall in available health visitors, average case loads in the majority of PCOs are shockingly high, with GPs warning the cuts could leave vulnerable children and families exposed.

Our investigation shows that health visitors in 43 of the 53 PCOs surveyed have an average caseload of more than one health visitor to every 300 children aged five and under – a key Government target.

The caseload threshold was recommended by Lord Laming last March, in his review of child care services commissioned by the Government in the wake of the Baby Peter case.

Some of the highest caseloads were seen in NHS Berkshire West, which currently has a ratio of one health visitor to every 2,240 families. Health visitors in NHS Hounslow have an average caseload nearly three times that recommended by Lord Laming, at one for every 800 children.

Health visitors in NHS Redbridge, NHS Derby City, NHS Berkshire East, NHS Camden, NHS West Kent, NHS Birmingham East and North, NHS Trafford, NHS Manchester, NHS North East Essex and NHS Heart of Birmingham all had average caseloads of 500 children or more.

PCOs are also drastically scaling back the provision of health visitors in some areas. NHS Berkshire West, NHS Hastings & Rother, NHS Havering and NHS Wakefield have all cut their whole-time equivalent number of health visitors by more than 20% over the last three years, with the most drastic reduction - 43% - seen in NHS North Yorkshire and York.

In many areas health visitors have been removed from general practice and transferred elsewhere as part of a shake-up in community health service provision.

Dr John Montgomery, a GP in Glasgow – one of the most deprived areas on Scotland – fought and won a battle with NHS Greater Glasgow and Clyde by delivering a petition with the signatures of 30,000 patients to the Scottish Parliament, protesting against the removal of health visitors from his practice.

He told Pulse: ‘We have attached health visitors who will literally work in the same building as GPs. That's increasingly rare in general practice.'

‘The work health visitors do is so important to us here. We see the benefits in terms of child immunisation uptake. Glasgow has a high level of deprivation and 85% of the most deprived practices in Scotland. But we have an immunisation uptake of more than 90%.'

‘Health visitors also help vulnerable families and children. If we had concerns about a child, we can knock on their door. That's incredibly useful. Cases like Baby Peter highlight what happens when there's a lack of communication between GPs and health visitors.'

Health visitors play an important role in general practice Guest editor Dr Georgina Brown


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