The editorial on child health in the July issue brings up several points that probably need expanding1 as it is hugely important to the whole essence of family medicine and its future.
How many general practice vocational training schemes do not offer paediatrics as a core element of training and how many doctors in training now do a paediatric exam to show competency?
The out-of-hours services are staffed by GPs but many ill children never get past the triage system and, anecdotally, parents want more than telephone advice and so vote with their feet and turn up in A&E. The most deprived households are likely to be car-free and as such unable to get to remote out-of-hours bases, but do not fit visiting criteria set by the out-of-hours companies. How can these conundrums be solved?
Pregnant women in our area are directed away from seeing their GP; again anecdotally many women seem not to be aware of folic acid or vitamin D advice prior to their pregnancy. We need to address this in contraceptive reviews.
There are now waiting lists for paediatric outpatients that were rare in the past despite the number referred remaining very low. The clinics seem to spend a lot of time reviewing children who should be in primary care (stable asthma for example). Here I hope commissioning can make changes.
The breakdown in health visiting services, the removal of paediatric checks (after 6 weeks) from general practice all seem to have happened without any local decision making. Were our representatives involved in these changes?
The model for best paediatric care in busy urban areas may be different from those of us in small towns 25 miles away from hospitals. But unless we put our own house in order and provide highly-skilled, prompt, comprehensive primary paediatric care, then it will be another nail in the coffin of ‘general practice’ if we lose paediatric care as part of our core role.
- © British Journal of General Practice 2012
