Mike Fitzpatrick is clearly struggling with child protection and probably finds resonance with other GPs who feel the same.1 Careless words cost lives, and I believe Mike and the editors of the Journal should remember this.
As a medical student I was drawn to general practice by the The Journal of the Royal College of General Practitioners and the RCGP focus on the physical, psychological, and social components of the consultation. I was very fortunate to have trained in practice with the late Dr Eric Gambrill, where this spirit of working together with other professionals in challenging cases was promoted with enthusiasm. It is sad to see the Journal potentially helping to erect barriers to safeguarding children. As a GP and a Named Doctor for Safeguarding Children, may I suggest the following:
Don’t give up on safeguarding children. Read the PreVAil report showing the continuum of abuse and neglect in infancy to conditions in later life, including academic failure, substance misuse, mental health disorder, maltreatment of one’s own offspring, and chronic disease including heart disease and cancer.2
Read the article ‘Beyond the specific child’ that highlights the fact that child protection cases in general practice so often present through parental issues and concerns, and suggests a refocus.3
Continue to voice concerns about excessive child safeguarding guidance, (strident or not), and at the same time call for better resources for the complex tasks in primary care. Bearing in mind the PreVAil report, this may be more worth while than ticking boxes for QoF points.
Consider the Common Assessment Framework (CAF) as a friend. It is the best tool we have for analytical assessment of complex cases not unlike the landmark RCGP trial I mentioned above.4
Look at the RCGP/National Society for Prevention of Cruelty to Children Toolkit for Safeguarding Children and Young People (section on Child Protection Conferences, page 36).5 You will note that it highlights the three main headings of the CAF: child’s developmental needs, parenting capacity, and family and environmental factors. The Toolkit goes on to consider key points to include from a GP perspective. Perhaps use this to set up your own template.
If we manage to contribute to make even one or two children’s lives better per GP per year through safeguarding, we may be rewarded by seeing their health and wellbeing improved and may even be thanked by future GPs who have one or two adults less scarred forever by child abuse and neglect.
REFERENCES
- 1.Fitzpatrick M. How to protect general practice from child protection. Br J Gen Pract. 2011;61(585):299. doi: 10.3399/bjgp11X567315. [DOI] [PMC free article] [PubMed] [Google Scholar]
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- 3.Hølge-Hazelton B, Tulinius C. Beyond the specific child. What is a ‘child’s case’ in general practice? Br J Gen Pract. 2010;60(570):e4–9. doi: 10.3399/bjgp10X482059. DOI: 10.3399/bjgp10X482059. [DOI] [PMC free article] [PubMed] [Google Scholar]
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