How to protect general practice from child protection

Mike Fitzpatrick's views1 are outdated. He begins his article by mentioning the tragic cases of Victoria Climbié and Peter Connelly (Baby P): in both cases the GPs were found to be negligent. He attempts to undermine the whole system of safeguarding. It is a cynical denial of what is a very real problem.

He is right to say that we should not be driven by media hysteria; that some cases will always be missed; and that attention is needed to contentious issues such as referral forms, case conferences in surgery hours, and impenetrable minutes. The Common Assessment Framework (CAF) referral form that he describes, for which, by the way, parental consent is usually required, is under Eileen Munro's beady eye2 at the moment. The CAF process was intended to help early intervention and is evidence based.3

He advocates that community paediatricians should mediate between GPs and the child protection system, but referrals are rarely straightforward. Safeguarding issues are uncovered in the process of investigating and treating other conditions, including adult ones, and the child is not complaining. Community paediatricians do not always have the same contact with children and their families or know them well.

I am most disturbed by Mike Fitzpatrick's explanation of the nature of general practice. He describes our job as simply attempting to diagnose and treat people when we see them episodically and infrequently. He says we should not ‘adopt the role of social worker, psychologist, police, or priest’. But we are to get to know our patients, their families, and their circumstances. We are to understand and care for them as whole people, not just to diagnose and treat their episodic conditions. We are GPs; gatekeepers to all the specialist treatments the NHS has to offer; and called to know, love, and care for people in the context in which they find themselves, at every stage of their lives. When a case conference is needed it would be farcical without the GP present and playing a major part.

• © British Journal of General Practice, May 2011