This article gives good advice on how to write a report for an ICPC.1 It identifies a key issue, however, that is not addressed at all: that ‘GPs have been poor attenders at ICPCs’.
GPs can have a fundamental reluctance to engage in a process that is perceived as undermining the doctor– patient relationship. The GP is often the only professional at an ICPC who has a therapeutic relationship with the parent(s) as well as with the child. We are very aware that inside every vulnerable adult is likely a child who endured trauma themselves, and comes to us as an adult figure whom they can trust. These are the very patients whose parenting is likely to cause child protection concerns. Being asked to provide information that may protect one child can sometimes feel like an act of betrayal, and even abuse, of the other child within the adult parent. This undoubtedly leads to us under-reporting and carrying a lot of risk.
As a Deep End GP I believe this is one of the reasons why GPs are reluctant to work in disadvantaged areas. We often deal with this dilemma by either not engaging, or by doing a report, but not attending the meeting, because of the sense of being complicit in a perception of judgement and criticism of the parent. This can have the unintended consequence of the parent/patient feeling abandoned by us.
Paradoxically, I have concluded that the best way to protect both the child and the vulnerable adult is to thoroughly engage with the process: to not only be open with the parent about concerns but also explicit that you will walk with them on what can be a harrowing journey. With our knowledge of families we can have a critical input. Our independence allows us to challenge other services. And, finally, we can support and advocate for the vulnerable parent as well as the child, regardless of the outcome.
This is not a comfortable space for GPs, but it is a challenge we need to consider if we are to meet our responsibilities to all our patients.
- © British Journal of General Practice 2020