The Chief Medical Officer, Prof Dame Sally Davies, published her 2012 report recently – Our children deserve better: prevention pays. The 10th recommendation in her summary section is that ‘children with long-term conditions, as vulnerable people, should have a named GP who co-ordinates their disease management’. But what would the implications of this be?
First we need to bear in mind that, compared to other economically advanced nations, children and young people in the UK have poor general health, particularly for long-term conditions such as diabetes, epilepsy, asthma, learning disabilities and renal rejection after transplant and self-assessed rates of well-being. Children and young people who are ‘looked after’ in the care system, are most at risk of not doing well (especially those from black minority ethnic backgrounds).1There is also too much variation between different areas, even adjusted for relative poverty, so the NHS has a few child health challenges still to work on.
The benefit of having a named GP would mean that children with long-term conditions would have a level of continuity with at least one GP who knows the child in the context of their family. The named GP wouldn’t have to be there every time the child was seen, but would need to know what the child’s specific plan was and how it was working out and adjust or help as needed. However, the CMO’s statement does not define the named GP so she could mean the usual GP, the practice child health lead, a GP with an extended interest, or a GP similar to the ‘named GP’ for safeguarding.
Implementing a system of named GPs would show that we accept that healthcare for children in this country needs to improve but we can not expect it to solve all of the issues or barriers to accessing care that young people in Britain face.
Dependency, and care-planning challenges
Children and young people could have difficulties accessing healthcare because many depend on someone else to make appointments for them. Some may not be registered with a GP due to frequent moves and lack of ‘health literacy’ on the part of their parent or guardian. Young people cite stigma, not being heard, and confidentiality as potential barriers to accessing care.2
There are also many complex aspects to developing and maintaining a specific care plan for a child. Some of these might only be over-complicated by allocating a young patient to a named GP who may initially be unfamiliar with the family and social context of the child.
While a plan for a child with a long-term condition involves disease management, it also includes social care. Good communication between different professionals is essential. One challenge in care plans is balancing the child’s and parents’ needs, bearing in mind the complex ‘coming together of social and genetic factors across generations’.2
Improving access for young patients
Another challenge for giving children and young people better access to GP services is the GP appointment system. It is important to develop case-based discussions, seek the support of colleagues in the practice, get feedback from children and parents themselves, and liaise closely with other parties (secondary care, specialist nurses, joint clinics, and consultants) to ensure that children and young people are receiving the best care they can.
More than ever, all GPs need to rely on communities themselves, such as local schools, public health, voluntary organisations, CCGs and faith groups who all contribute to wellbeing and health. Supporting carers and those with language difficulties, signposting information resources and advocacy are important challenges that most GPs dealing with children come across.
While some GPs are better able to deal with all of these issues than others, it seems important that all GPs should be encouraged to take these areas seriously.
Perhaps rather than each practice or area having one GP who deals with all children with long-term conditions, a more appropriate model of named GPs might be for each GP to take on a certain number of these cases. This would mean that they were more able to support, educate and challenge other GPs with a broader perspective.
However, there are important resource implications for GPs, and a need for more administrative and nursing support if the Department of Health wants their recommendations to be enacted.
Dr Janice Allister is the RCGP expert in child health, former chair of the Primary Care Child Safeguarding Forum, and a GP in Peterborough.
1 National Obesity Observatory 2011 Obesity and Ethnicity.
2 National Commissioning Board. Opening the door to better healthcare; making sure General Practice is working for children and young people. May 2013