‘As one senior GP put it to me, “some GPs don't even know how to hold a baby”1
In compiling his review of children's services commissioned by the NHS Executive, Professor Sir Ian Kennedy tells us that he ‘travelled around England and spoke to a great many people’.1 Indeed, an appendix lists hundreds of authorities he consulted and institutions he visited. Yet, although he has a great deal to say about GPs and general practice, he seems not to have set foot in a single surgery and to have spoken to only one GP — Professor Steve Field, the then chair of the Royal College of General Practitioners. Professor Kennedy does not say whether Professor Field was ‘the senior GP’ whose spirit of professional self-abasement helpfully provided him with the pithy comment cited above that so accurately reflects his own contemptuous view of GPs' skills in child care.
In his introduction, Professor Kennedy reminds readers that it is 30 years since he first ‘lamented the state of health and health care of children’.2 Many will also recall how this academic lawyer used the Reith Lectures to launch a bitter polemic, endorsing a ‘consumerist challenge’ to self-regulation and promoting an individualist gospel of health promotion — an agenda he has pursued with ever-increasing government backing over the intervening decades.
Professor Kennedy provides a striking illustration of the ambivalence of the political elite towards the medical profession. On the one hand they are envious that doctors retain the status and authority that other professions (such as politicians, lawyers, and clergymen) have lost; on the other, they nurture a burning resentment that leads them to strive to drag doctors into the gutter with the rest of them.
The Kennedy Report reflects the familiar view that GPs hold the answer to every problem of society. In relation to children, they must become ‘not so much the “gatekeepers” of the past, more the “navigators” of the future’.1 At the same time, Kennedy claims that GPs have ‘little or no experience of paediatrics’, they ‘lack the confidence to assess and treat children effectively’,1 they provide a poor service to disabled children and fail to attend child protection case conferences.
The solution to GPs' supposed deficiencies in paediatrics is familiar: more training. This proposal is supported by the claim that ‘in many parts of the country, 40–50% will have had no formal paediatric/child health training’.1 This rigorous statistic, typical of the poor quality of the evidence on which this report is based, is backed with a reference to an unpublished survey carried out by the Royal College of Paediatrics and Child Health.
In his recommendations, Professor Kennedy recycles every cliché and platitude of past reports. Here is a typical combination of empty rhetoric and wishful thinking:
‘The connections and interactions of the various services can be choreographed so as to make them truly complementary. Savings in terms of greater efficiency, early intervention and the avoidance of duplication will be immediately realised.’1
The enduring mystery of the Kennedy Report is why the former chair of the RCGP should have allowed his name to remain on a document that is so prejudiced and ill-informed about general practice that it can make no useful contribution towards the real problems of providing better health care for children.
- © British Journal of General Practice, 2010.
REFERENCES
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Department of Health. Getting it right for children and young people: overcoming cultural barriers in the NHS so as to meet their needs, .
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