Re: Safeguarding , role of GP

[Guest guest]

I suspect the problem is more than one of communication. GPs are

family doctors and tend to be responsible for parents and children,

which can't be easy if they're asked about sensitive issues like

parentlal mental health, drugs, etc. Things may have changed, but in

all my years of practice, I can't remember a GP ever attending a case

conference on a child although a few would talk to me beforehand

about cases.

Have things changed?

" " <SENATE-

HVSN >

From: Louise <loui_r@...>

Date sent: Sun, 6 May 2012 20:48:53 +0100

Subject: Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Hi ,The problem is indeed complex certainly in practice I feel some GP's are unsure what their role is in safeguarding.I also feel that limited value is placed on safeguarding and the need for GP input. If it were to be part if the QAOF I think it would be quite a different story. I have only seen a GP once at case conference in 8 years and that was because I insisted as it was a FI case ! Nothing has changed , it's incredibly frustrating .Regards,LouiseSent from my iPhoneOn 6 May 2012, at 23:37, hwood@... wrote:

I suspect the problem is more than one of communication. GPs are

family doctors and tend to be responsible for parents and children,

which can't be easy if they're asked about sensitive issues like

parentlal mental health, drugs, etc. Things may have changed, but in

all my years of practice, I can't remember a GP ever attending a case

conference on a child although a few would talk to me beforehand

about cases.

Have things changed?

" " <SENATE-

HVSN >

From: Louise <loui_r@...>

Date sent: Sun, 6 May 2012 20:48:53 +0100

Subject: Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Hi Louise

I used to find it frustrating too, but it seems it's about more than

avoiding the work involved. Maybe this sort of problem is going to

remain one of real conflict for our GP colleagues? I think they have

an understanding of childhood and its needs, child health and child

development which makes the issues of abuse and neglect and the

effects on children pretty clear, so it's not a lack of understanding

of the effects on children. In fact, I'd guess they probably have a

better understanding of child health than wider issues of public

health or the implications of health commissioning. Whether that

amounts to be able to recognise possibkle maltreatment when they see

it, I'm less sure. Kimberley Carlile's GP was confident he'd never

seen a case in all his years of medical practice.

GPs don't have the same type of one to one relationship with

patients, families & communities they used to have. We're not in

Tannochbrae anymore. Most of the practice team I've been registered

with for 10 years would pass me in the street without a flicker of

recognition on either side. As health visitors, we do have a

different kind of exposure to children and families in their homes

and our contacts are driven by a different agenda from patient

instigated reports of illness. We're obviously servants of the

state, as well as a helpful service. Our contacts aren't just

responsive ones and they don't all take place on surgery premises, so

we get a little bit more of an impression of what's going on in

families & communities. Maybe this kind of work gives us a different

perspective, more child centred?

The US made suspected child abuse cases subject to mandatory

reporting, so doctors there have to to do so. It's a very different

system. I'm not sure how making child protection involvement

mandatory for GPs would work here, but it's an interesting idea.

" " < >

From: Louise <loui_r@...>

Date sent: Mon, 7 May 2012 08:08:28 +0100

Subject: Re: Safeguarding , role of GP

Send reply to:

Hi ,

The problem is indeed complex certainly in practice I feel some GP's

are unsure what their role is in safeguarding.I also feel that

limited value is placed on safeguarding and the need for GP input. If

it were to be part if the QAOF I think it would be quite a different

story. I have only seen a GP once at case conference in 8 years and

that was because I insisted as it was a FI case ! Nothing has changed

, it's incredibly frustrating .

Regards,

Louise

Sent from my iPhone

On 6 May 2012, at 23:37, hwood@... wrote:

I suspect the problem is more than one of communication. GPs are

family doctors and tend to be responsible for parents and children,

which can't be easy if they're asked about sensitive issues like

parentlal mental health, drugs, etc. Things may have changed, but in

all my years of practice, I can't remember a GP ever attending a case

conference on a child although a few would talk to me beforehand

about cases.

Have things changed?

" " <SENATE-

HVSN >

From: Louise <loui_r@...>

Date sent: Sun, 6 May 2012 20:48:53 +0100

Subject: Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Dear ,

You mention that in the States, "doctors have to report". This does not mean that they do report.

In the United States, there is no absolute requirement to do anything about child neglect or ill treatment. Action is entirely down to State guidelines and to District guidelines. Most children in the country receive far less health and medical attention than do children in this country and that includes no care when a child is in need of care -- particularly if the child's family or local district is poor. And 30% of families in the country live below the relative poverty line.

Children in that 30% of the population probably never see a doctor. And we do know that poverty is a severe risk factor for child neglect, etc.

And the USA has never signed the UN Convention on the Rights of the Child.

I would be v interested to discover the source of the information you read. I've just come back from 5 months teaching Social Policy and Inequality at a university in the States. Depressing picture in much of the country.

All good wishes,

Diane

Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Hi ,I agree with you that as HVs we are more child centred , I also believe that we are explicit about our priorities when working with families, this seems less clear for GPs especially when they have been involved with families for generations .One of the most frequent discussions I have certainly with the GPs I work with is the cost implication of attending conferences given the need to then cover the morning or afternoon session with a locum GP. Not too long ago a GP sent a bill for a case conference report he had written ! I think some GPs are willing to play a more active part in the process but perhaps its the system that adds to the failure. It would be interesting to know what areas are doing to combat the problem perhaps case conferences on GP premises

.. Louise From: "hwood@..." <hwood@...> Sent: Monday, 7 May 2012, 11:03 Subject: Re: Safeguarding , role of GP

Hi Louise

I used to find it frustrating too, but it seems it's about more than

avoiding the work involved. Maybe this sort of problem is going to

remain one of real conflict for our GP colleagues? I think they have

an understanding of childhood and its needs, child health and child

development which makes the issues of abuse and neglect and the

effects on children pretty clear, so it's not a lack of understanding

of the effects on children. In fact, I'd guess they probably have a

better understanding of child health than wider issues of public

health or the implications of health commissioning. Whether that

amounts to be able to recognise possibkle maltreatment when they see

it, I'm less sure. Kimberley Carlile's GP was confident he'd never

seen a case in all his years of medical practice.

GPs don't have the same type of one to one relationship with

patients, families & communities they used to have. We're not in

Tannochbrae anymore. Most of the practice team I've been registered

with for 10 years would pass me in the street without a flicker of

recognition on either side. As health visitors, we do have a

different kind of exposure to children and families in their homes

and our contacts are driven by a different agenda from patient

instigated reports of illness. We're obviously servants of the

state, as well as a helpful service. Our contacts aren't just

responsive ones and they don't all take place on surgery premises, so

we get a little bit more of an impression of what's going on in

families & communities. Maybe this kind of work gives us a different

perspective, more child centred?

The US made suspected child abuse cases subject to mandatory

reporting, so doctors there have to to do so. It's a very different

system. I'm not sure how making child protection involvement

mandatory for GPs would work here, but it's an interesting idea.

To: " " < >

From: Louise <loui_r@...>

Date sent: Mon, 7 May 2012 08:08:28 +0100

Subject: Re: Safeguarding , role of GP

Send reply to:

Hi ,

The problem is indeed complex certainly in practice I feel some GP's

are unsure what their role is in safeguarding.I also feel that

limited value is placed on safeguarding and the need for GP input. If

it were to be part if the QAOF I think it would be quite a different

story. I have only seen a GP once at case conference in 8 years and

that was because I insisted as it was a FI case ! Nothing has changed

, it's incredibly frustrating .

Regards,

Louise

Sent from my iPhone

On 6 May 2012, at 23:37, hwood@... wrote:

I suspect the problem is more than one of communication. GPs are

family doctors and tend to be responsible for parents and children,

which can't be easy if they're asked about sensitive issues like

parentlal mental health, drugs, etc. Things may have changed, but in

all my years of practice, I can't remember a GP ever attending a case

conference on a child although a few would talk to me beforehand

about cases.

Have things changed?

" " <SENATE-

HVSN >

From: Louise <loui_r@...>

Date sent: Sun, 6 May 2012 20:48:53 +0100

Subject: Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Hi Louise

Like me, I expect you wonder why we expect such different things from

different professional groups, though? Everybody's time costs money.

We're all professionals and we all have commitments to our patients

and clients. Every short notice meeting presents an opportunity cost

to other services we could be providing and I shall assume we all

want to play a part in safeguarding vulnerable children, so I guess

it could be down to the GP contract. Their links to public service

are through payments like this and my local practice has a group of

admin staff who spend their time chasing up such payments and

ensuring the claims paperwork is completed.

I wonder if you removed this particular perverse disincentive and had

a nice shiny taxi waiting at the surgery door, would it happen? The

contractual problems don't apply to adult mental health services or

substance misuse services, yet they don't attend much either. Out of

more than 90 SCR reports I read, only one had a full report from

adult psychiatric services, but parental mental health, drugs and

alcohol problems seemed very prominent in many other cases. Oh, and

none of them had any contribution whatsoever from a GP...

I hear the arguments but don't really understand this - probably too

child centred to be objective.

" " < >

From: Lou <loui_r@...>

Date sent: Mon, 7 May 2012 13:39:35 +0100 (BST)

Subject: Re: Safeguarding , role of GP

Send reply to:

Hi ,

I agree with you that as HVs we are more child centred , I also

believe that we are explicit about our priorities when working with

families, this seems less clear for GPs especially when they have

been involved with families for generations .

One of the most frequent discussions I have certainly with the GPs I

work with is the cost implication of attending conferences given the

need to then cover the morning or afternoon session with a locum GP.

Not too long ago a GP sent a bill for a case conference report he had

written ! I think some GPs are willing to play a more active part in

the process but perhaps its the system that adds to the failure. It

would be interesting to know what areas are doing to combat the

problem perhaps case conferences on GP premises .

Louise

From: " hwood@... " <hwood@...>

Sent: Monday, 7 May 2012, 11:03

Subject: Re: Safeguarding , role of GP

Hi Louise

I used to find it frustrating too, but it seems it's about more than

avoiding the work involved. Maybe this sort of problem is going to

remain one of real conflict for our GP colleagues? I think they have

an understanding of childhood and its needs, child health and child

development which makes the issues of abuse and neglect and the

effects on children pretty clear, so it's not a lack of understanding

of the effects on children. In fact, I'd guess they probably have a

better understanding of child health than wider issues of public

health or the implications of health commissioning. Whether that

amounts to be able to recognise possibkle maltreatment when they see

it, I'm less sure. Kimberley Carlile's GP was confident he'd never

seen a case in all his years of medical practice.

GPs don't have the same type of one to one relationship with

patients, families & communities they used to have. We're not in

Tannochbrae anymore. Most of the practice team I've been registered

with for 10 years would pass me in the street without a flicker of

recognition on either side. As health visitors, we do have a

different kind of exposure to children and families in their homes

and our contacts are driven by a different agenda from patient

instigated reports of illness. We're obviously servants of the

state, as well as a helpful service. Our contacts aren't just

responsive ones and they don't all take place on surgery premises, so

we get a little bit more of an impression of what's going on in

families & communities. Maybe this kind of work gives us a different

perspective, more child centred?

The US made suspected child abuse cases subject to mandatory

reporting, so doctors there have to to do so. It's a very different

system. I'm not sure how making child protection involvement

mandatory for GPs would work here, but it's an interesting idea.

" " < >

From: Louise <loui_r@...>

Date sent: Mon, 7 May 2012 08:08:28 +0100

Subject: Re: Safeguarding , role of GP

Send reply to:

Hi ,

The problem is indeed complex certainly in practice I feel some GP's

are unsure what their role is in safeguarding.I also feel that

limited value is placed on safeguarding and the need for GP input. If

it were to be part if the QAOF I think it would be quite a different

story. I have only seen a GP once at case conference in 8 years and

that was because I insisted as it was a FI case ! Nothing has changed

, it's incredibly frustrating .

Regards,

Louise

Sent from my iPhone

On 6 May 2012, at 23:37, hwood@... wrote:

I suspect the problem is more than one of communication. GPs are

family doctors and tend to be responsible for parents and children,

which can't be easy if they're asked about sensitive issues like

parentlal mental health, drugs, etc. Things may have changed, but in

all my years of practice, I can't remember a GP ever attending a case

conference on a child although a few would talk to me beforehand

about cases.

Have things changed?

" " <SENATE-

HVSN >

From: Louise <loui_r@...>

Date sent: Sun, 6 May 2012 20:48:53 +0100

Subject: Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Yes, I agree with you, Diane! I'm deeply sceptical about compulsion,

but it is one response to frustration when you see other priorities

taking precedence over the safety of children. It sometimes works,

for example in increasing seatbelt use in cars, reducing lung disease

deaths through banning smoking in public places and in making overt

racism & sexism in the workplace a bit more subtle in their

expression. Not everybody complies all the time, but if there is a

wider social conviction for change, it can reinforce it.

The effects on US child protection cases don't seem to have been very

good in this case. Seems to me that the US is unfortunately in one

of those times when the children of the poor and disadvantaged are

losing out badly and it's certainly reflected in their child

mortality statistics, which are very poor for a developed nation.

The Convention would have been mocked by any Federal government

signature under such circumstances. Some signatories haven't

ratified it either.

Quite apart from this macro perspective, it must be a very hard place

to be a caring professional trying to deliver services to that 30% of

excluded families you speak of. I do admire your working in this

social policy area and hope you were able to make an impact on your

students' understanding. I studied social and political philosophy

when the course was very focused on the debate on US health care

under Clinton and the reading was interesting, so I kept on reading

when the course finished.

From: ddebell@...

Date sent: Mon, 7 May 2012 07:33:48 -0400 (EDT)

Subject: Re: Safeguarding , role of GP

Send reply to:

Dear ,

You mention that in the States, " doctors have to report " . This does

not mean that they do report.

In the United States, there is no absolute requirement to do anything

about child neglect or ill treatment. Action is entirely down to

State guidelines and to District guidelines. Most children in the

country receive far less health and medical attention than do

childrenin this country and that includes no care when a child is in

need of care -- particularly if the child's family or local district

is poor. And30% of families in the country live below the relative

poverty line.

Childrenin that 30% of the population probably never see a

doctor. And we do know that poverty is a severe risk factor for

child neglect, etc.

And the USA has never signed the UN Convention on the Rights of the

Child.

I would be v interested to discover the source of the information you

read. I've just come back from 5 months teaching Social Policy and

Inequalityat a university in the States. Depressing picture in much

of the country.

Allgood wishes,

Diane

Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Hi and Louise safeguardPronunciation:/ˈseɪfgÉ‘Ëd/nouna measure taken to protect someone or something or to prevent something undesirable:thecharity called for tougher safeguards to protect Britain’s remaining natural forestsverb[with object]protect from harm or damage with an appropriate measure:aframework which safeguards employees from exploitationOrigin:late Middle English (denotingprotection or safe conduct): from Old French sauvegarde, from sauve 'safe'+ garde 'guard'.Compare with saggar I am sure that there is an issue at most GP practices that I have known about the financial consequences to the partners " profits " if GPs attend a case conference about one child for a whole morning or afternoon when back at the surgerythey could be seeing 15- 20 patients. However there is a deeper issue here which needs to be considered. ALthough , against all the odds , some GPs do try to devote some time to the theory and practice of preventative medicine our contract andtherefore our income depends on meeting the PCT targets both for the basic payments to the practice just for being there and being open and for the various extra payments for QOF targets met and other LES (local enhanced service) payments. Thismeans in effect - driven by the GP partners and by the practice managers - that if there is no payment for a service or for attending a meeting then it is not considered " cost effective " for GPs or practice nurses or any GP practice staff to offer service orattenda meeting. As a result not only are child safeguarding meetings not attended but other meetings relating to " the learning needs of patients and carers " // the support care homes need in care assistant training and education // " Library and Health " meetingsand much more are not even being imagined let alone attended. The long history of GP practice in the UK is thatwe must not go out into the community and get involved in personal, family or community affairs ( except as volunteers in our own time such as work with the St s Ambulance ) but stay in our consulting rooms and attend to the sickwhen they ask for help. In this way , and in this way alone, we build up our local reputation as competent, honest, trustworthy GPs. - attempts to get involved in anything outside the consulting room in trying to prevent ill health or protect peopleincluding children from harm is not encouraged and as I have learnt to my cost can lead to accusations that you are indicating that you are a better GP than the GP in the next room or in the next practice - such accusations can have serious adverse effectsupon the GPs career prospects. I could write much more but this is a complex issue that needs much further thought and discussion . Regards Malcolm GP North Somerset. From: [ ] On Behalf Of hwood@... [hwood@...]Sent: 07 May 2012 15:11 Subject: Re: Safeguarding , role of GP Hi LouiseLike me, I expect you wonder why we expect such different things from different professional groups, though? Everybody's time costs money. We're all professionals and we all have commitments to our patients and clients. Every short notice meeting presents an opportunity cost to other services we could be providing and I shall assume we all want to play a part in safeguarding vulnerable children, so I guess it could be down to the GP contract. Their links to public service are through payments like this and my local practice has a group of admin staff who spend their time chasing up such payments and ensuring the claims paperwork is completed.I wonder if you removed this particular perverse disincentive and had a nice shiny taxi waiting at the surgery door, would it happen? The contractual problems don't apply to adult mental health services or substance misuse services, yet they don't attend much either. Out of more than 90 SCR reports I read, only one had a full report from adult psychiatric services, but parental mental health, drugs and alcohol problems seemed very prominent in many other cases. Oh, and none of them had any contribution whatsoever from a GP...I hear the arguments but don't really understand this - probably too child centred to be objective. " " < >From: Lou <loui_r@...>Date sent: Mon, 7 May 2012 13:39:35 +0100 (BST)Subject: Re: Safeguarding , role of GPSend reply to: Hi , I agree with you that as HVs we are more child centred , I also believe that we are explicit about our priorities when working with families, this seems less clear for GPs especially when they have been involved with families for generations . One of the most frequent discussions I have certainly with the GPs I work with is the cost implication of attending conferences given the need to then cover the morning or afternoon session with a locum GP. Not too long ago a GP sent a bill for a case conference report he had written ! I think some GPs are willing to play a more active part in the process but perhaps its the system that adds to the failure. It would be interesting to know what areas are doing to combat the problem perhaps case conferences on GP premises .Louise From: " hwood@... " <hwood@...> Sent: Monday, 7 May 2012, 11:03Subject: Re: Safeguarding , role of GPHi LouiseI used to find it frustrating too, but it seems it's about more thanavoiding the work involved. Maybe this sort of problem is going toremain one of real conflict for our GP colleagues? I think they havean understanding of childhood and its needs, child health and childdevelopment which makes the issues of abuse and neglect and theeffects on children pretty clear, so it's not a lack of understandingof the effects on children. In fact, I'd guess they probably have abetter understanding of child health than wider issues of publichealth or the implications of health commissioning. Whether thatamounts to be able to recognise possibkle maltreatment when they seeit, I'm less sure. Kimberley Carlile's GP was confident he'd neverseen a case in all his years of medical practice.GPs don't have the same type of one to one relationship withpatients, families & communities they used to have. We're not inTannochbrae anymore. Most of the practice team I've been registeredwith for 10 years would pass me in the street without a flicker ofrecognition on either side. As health visitors, we do have adifferent kind of exposure to children and families in their homesand our contacts are driven by a different agenda from patientinstigated reports of illness. We're obviously servants of thestate, as well as a helpful service. Our contacts aren't justresponsive ones and they don't all take place on surgery premises, sowe get a little bit more of an impression of what's going on infamilies & communities. Maybe this kind of work gives us a differentperspective, more child centred?The US made suspected child abuse cases subject to mandatoryreporting, so doctors there have to to do so. It's a very differentsystem. I'm not sure how making child protection involvementmandatory for GPs would work here, but it's an interesting idea. " " < >From: Louise <loui_r@...>Date sent: Mon, 7 May 2012 08:08:28 +0100Subject: Re: Safeguarding , role of GPSend reply to: Hi ,The problem is indeed complex certainly in practice I feel some GP'sare unsure what their role is in safeguarding.I also feel thatlimited value is placed on safeguarding and the need for GP input. Ifit were to be part if the QAOF I think it would be quite a differentstory. I have only seen a GP once at case conference in 8 years andthat was because I insisted as it was a FI case ! Nothing has changed, it's incredibly frustrating .Regards,LouiseSent from my iPhoneOn 6 May 2012, at 23:37, hwood@... wrote:I suspect the problem is more than one of communication. GPs arefamily doctors and tend to be responsible for parents and children,which can't be easy if they're asked about sensitive issues likeparentlal mental health, drugs, etc. Things may have changed, but inall my years of practice, I can't remember a GP ever attending a caseconference on a child although a few would talk to me beforehandabout cases.Have things changed? " " < >From: Louise <loui_r@...>Date sent: Sun, 6 May 2012 20:48:53 +0100Subject: Safeguarding , role of GPSend reply to: [ Double-click this line for list subscription options ]Dear Senators,I am looking at the Gp role in safeguarding ,is anyone aware of GP'sactively involved in case conferences via Skype or perhaps videoconferencing? There is clearly some difficulty in getting Gp's toattend conferences yet they are often well placed to make valuedcontributions to the process .If anybody is aware of good practicethat might be replicated elsewhere I would love to hear from you.Regards, Louise (HV) CambsSent from my iPhone------------------------------------

[Guest guest]

Hi Malcolm I just love your analysis – it needs digesting. On the safeguarding leadership course my colleague and I run we have had some excellent GPs who try very hard to get their colleagues involved. Most of those we have had attend are passionate about safeguarding and it is so good to see. But I do realise the constraints as you describe. Hope we can sort this and make CCGs make happen in the right way for the  safeguarding agenda. Margaret From: [mailto: ] On Behalf Of Rigler Malcolm (NORTH SOMERSET PCT)Sent: 07 May 2012 16:35 Subject: RE: Safeguarding , role of GP Hi and Louise safeguardPronunciation:/ˈseɪfgÉ‘Ëd/noun· a measure taken to protect someone or something or to prevent something undesirable:the charity called for tougher safeguards to protect Britain’s remaining natural forestsverb[with object] · protect from harm or damage with an appropriate measure:a framework which safeguards employees from exploitationOrigin:late Middle English (denoting protection or safe conduct): from Old French sauve garde, from sauve 'safe' + garde 'guard'. Compare with saggar I am sure that there is an issue at most GP practices that I have known about the financial consequences to the partners " profits " if GPs attend a case conference about one child for a whole morning or afternoon when back at the surgery they could be seeing 15- 20 patients. However there is a deeper issue here which needs to be considered. ALthough , against all the odds , some GPs do try to devote some time to the theory and practice of preventative medicine our contract and therefore our income depends on meeting the PCT targets both for the basic payments to the practice just for being there and being open and for the various extra payments for QOF targets met and other LES (local enhanced service) payments. This means in effect - driven by the GP partners and by the practice managers - that if there is no payment for a service or for attending a meeting then it is not considered " cost effective " for GPs or practice nurses or any GP practice staff to offer service orattend a meeting. As a result not only are child safeguarding meetings not attended but other meetings relating to " the learning needs of patients and carers " // the support care homes need in care assistant training and education // " Library and Health " meetings and much more are not even being imagined let alone attended. The long history of GP practice in the UK is that we must not go out into the community and get involved in personal, family or community affairs ( except as volunteers in our own time such as work with the St s Ambulance ) but stay in our consulting rooms and attend to the sick when they ask for help. In this way , and in this way alone, we build up our local reputation as competent, honest, trustworthy GPs. - attempts to get involved in anything outside the consulting room in trying to prevent ill health or protect people including children from harm is not encouraged and as I have learnt to my cost can lead to accusations that you are indicating that you are a better GP than the GP in the next room or in the next practice - such accusations can have serious adverse effects upon the GPs career prospects. I could write much more but this is a complex issue that needs much further thought and discussion . Regards Malcolm GP North Somerset. From: [ ] On Behalf Of hwood@... [hwood@...]Sent: 07 May 2012 15:11 Subject: Re: Safeguarding , role of GP Hi LouiseLike me, I expect you wonder why we expect such different things from different professional groups, though? Everybody's time costs money. We're all professionals and we all have commitments to our patients and clients. Every short notice meeting presents an opportunity cost to other services we could be providing and I shall assume we all want to play a part in safeguarding vulnerable children, so I guess it could be down to the GP contract. Their links to public service are through payments like this and my local practice has a group of admin staff who spend their time chasing up such payments and ensuring the claims paperwork is completed.I wonder if you removed this particular perverse disincentive and had a nice shiny taxi waiting at the surgery door, would it happen? The contractual problems don't apply to adult mental health services or substance misuse services, yet they don't attend much either. Out of more than 90 SCR reports I read, only one had a full report from adult psychiatric services, but parental mental health, drugs and alcohol problems seemed very prominent in many other cases. Oh, and none of them had any contribution whatsoever from a GP...I hear the arguments but don't really understand this - probably too child centred to be objective. " " < >From: Lou <loui_r@...>Date sent: Mon, 7 May 2012 13:39:35 +0100 (BST)Subject: Re: Safeguarding , role of GPSend reply to: Hi , I agree with you that as HVs we are more child centred , I also believe that we are explicit about our priorities when working with families, this seems less clear for GPs especially when they have been involved with families for generations . One of the most frequent discussions I have certainly with the GPs I work with is the cost implication of attending conferences given the need to then cover the morning or afternoon session with a locum GP. Not too long ago a GP sent a bill for a case conference report he had written ! I think some GPs are willing to play a more active part in the process but perhaps its the system that adds to the failure. It would be interesting to know what areas are doing to combat the problem perhaps case conferences on GP premises .Louise From: " hwood@... " <hwood@...> Sent: Monday, 7 May 2012, 11:03Subject: Re: Safeguarding , role of GPHi LouiseI used to find it frustrating too, but it seems it's about more thanavoiding the work involved. Maybe this sort of problem is going toremain one of real conflict for our GP colleagues? I think they havean understanding of childhood and its needs, child health and childdevelopment which makes the issues of abuse and neglect and theeffects on children pretty clear, so it's not a lack of understandingof the effects on children. In fact, I'd guess they probably have abetter understanding of child health than wider issues of publichealth or the implications of health commissioning. Whether thatamounts to be able to recognise possibkle maltreatment when they seeit, I'm less sure. Kimberley Carlile's GP was confident he'd neverseen a case in all his years of medical practice.GPs don't have the same type of one to one relationship withpatients, families & communities they used to have. We're not inTannochbrae anymore. Most of the practice team I've been registeredwith for 10 years would pass me in the street without a flicker ofrecognition on either side. As health visitors, we do have adifferent kind of exposure to children and families in their homesand our contacts are driven by a different agenda from patientinstigated reports of illness. We're obviously servants of thestate, as well as a helpful service. Our contacts aren't justresponsive ones and they don't all take place on surgery premises, sowe get a little bit more of an impression of what's going on infamilies & communities. Maybe this kind of work gives us a differentperspective, more child centred?The US made suspected child abuse cases subject to mandatoryreporting, so doctors there have to to do so. It's a very differentsystem. I'm not sure how making child protection involvementmandatory for GPs would work here, but it's an interesting idea. " " < >From: Louise <loui_r@...>Date sent: Mon, 7 May 2012 08:08:28 +0100Subject: Re: Safeguarding , role of GPSend reply to: Hi ,The problem is indeed complex certainly in practice I feel some GP'sare unsure what their role is in safeguarding.I also feel thatlimited value is placed on safeguarding and the need for GP input. Ifit were to be part if the QAOF I think it would be quite a differentstory. I have only seen a GP once at case conference in 8 years andthat was because I insisted as it was a FI case ! Nothing has changed, it's incredibly frustrating .Regards,LouiseSent from my iPhoneOn 6 May 2012, at 23:37, hwood@... wrote:I suspect the problem is more than one of communication. GPs arefamily doctors and tend to be responsible for parents and children,which can't be easy if they're asked about sensitive issues likeparentlal mental health, drugs, etc. Things may have changed, but inall my years of practice, I can't remember a GP ever attending a caseconference on a child although a few would talk to me beforehandabout cases.Have things changed? " " < >From: Louise <loui_r@...>Date sent: Sun, 6 May 2012 20:48:53 +0100Subject: Safeguarding , role of GPSend reply to: [ Double-click this line for list subscription options ]Dear Senators,I am looking at the Gp role in safeguarding ,is anyone aware of GP'sactively involved in case conferences via Skype or perhaps videoconferencing? There is clearly some difficulty in getting Gp's toattend conferences yet they are often well placed to make valuedcontributions to the process .If anybody is aware of good practicethat might be replicated elsewhere I would love to hear from you.Regards, Louise (HV) CambsSent from my iPhone------------------------------------

[Guest guest]

Hi Malcolm,Your comments are very thought provoking and I certainly get it , I do feel though that there is significant need for improvement how that happens is another question! Interestingly I have just written a research proposal for my MSc looking at IPE for nurses and medics , every little helps !Kind Regards,LouiseSent from my iPhoneOn 7 May 2012, at 16:35, "Rigler Malcolm (NORTH SOMERSET PCT)" <m.rigler@...> wrote:

Hi and Louise

safeguard

Pronunciation:/ˈseɪfgÉ‘Ëd/

noun

a measure taken to protect someone or something or to prevent something undesirable:the

charity called for tougher safeguards to protect Britain’s remaining natural forests

verb

[with object]

protect from harm or damage with an appropriate measure:a

framework which safeguards employees from exploitation

Origin:

late Middle English (denoting

protection or safe conduct): from Old French sauve

garde, from sauve 'safe'

+ garde 'guard'.

Compare with saggar

I am sure that there is an issue at most GP practices that I have known about the financial consequences to the partners "profits" if GPs attend a case conference about one child for a whole morning or afternoon when back at the surgery

they could be seeing 15- 20 patients.

However there is a deeper issue here which needs to be considered. ALthough , against all the odds , some GPs do try to devote some time to the theory and practice of preventative medicine our contract and

therefore our income depends on meeting the PCT targets both for the basic payments to the practice just for being there and being open and for the various extra payments for QOF targets met and other LES (local enhanced service) payments. This

means in effect - driven by the GP partners and by the practice managers - that if there is no payment for a service or for attending a meeting then it is not considered "cost effective" for GPs or practice nurses or any GP practice staff to offer service orattend

a meeting. As a result not only are child safeguarding meetings not attended but other meetings relating to "the learning needs of patients and carers" // the support care homes need in care assistant training and education // "Library and Health" meetings

and much more are not even being imagined let alone attended.

The long history of GP practice in the UK is that

we must not go out into the community and get involved in personal, family or community affairs ( except as volunteers in our own time such as work with the St s Ambulance ) but stay in our consulting rooms and attend to the sick

when they ask for help. In this way , and in this way alone, we build up our local reputation as competent, honest, trustworthy GPs. - attempts to get involved in anything outside the consulting room in trying to prevent ill health or protect people

including children from harm is not encouraged and as I have learnt to my cost can lead to accusations that you are indicating that you are a better GP than the GP in the next room or in the next practice - such accusations can have serious adverse effects

upon the GPs career prospects.

I could write much more but this is a complex issue that needs much further thought and discussion .

Regards

Malcolm

GP North Somerset.

From: [ ] On Behalf Of hwood@... [hwood@...]

Sent: 07 May 2012 15:11

Subject: Re: Safeguarding , role of GP

Hi Louise

Like me, I expect you wonder why we expect such different things from

different professional groups, though? Everybody's time costs money.

We're all professionals and we all have commitments to our patients

and clients. Every short notice meeting presents an opportunity cost

to other services we could be providing and I shall assume we all

want to play a part in safeguarding vulnerable children, so I guess

it could be down to the GP contract. Their links to public service

are through payments like this and my local practice has a group of

admin staff who spend their time chasing up such payments and

ensuring the claims paperwork is completed.

I wonder if you removed this particular perverse disincentive and had

a nice shiny taxi waiting at the surgery door, would it happen? The

contractual problems don't apply to adult mental health services or

substance misuse services, yet they don't attend much either. Out of

more than 90 SCR reports I read, only one had a full report from

adult psychiatric services, but parental mental health, drugs and

alcohol problems seemed very prominent in many other cases. Oh, and

none of them had any contribution whatsoever from a GP...

I hear the arguments but don't really understand this - probably too

child centred to be objective.

" " < >

From: Lou <loui_r@...>

Date sent: Mon, 7 May 2012 13:39:35 +0100 (BST)

Subject: Re: Safeguarding , role of GP

Send reply to:

Hi ,

I agree with you that as HVs we are more child centred , I also

believe that we are explicit about our priorities when working with

families, this seems less clear for GPs especially when they have

been involved with families for generations .

One of the most frequent discussions I have certainly with the GPs I

work with is the cost implication of attending conferences given the

need to then cover the morning or afternoon session with a locum GP.

Not too long ago a GP sent a bill for a case conference report he had

written ! I think some GPs are willing to play a more active part in

the process but perhaps its the system that adds to the failure. It

would be interesting to know what areas are doing to combat the

problem perhaps case conferences on GP premises .

Louise

From: "hwood@..." <hwood@...>

Sent: Monday, 7 May 2012, 11:03

Subject: Re: Safeguarding , role of GP

Hi Louise

I used to find it frustrating too, but it seems it's about more than

avoiding the work involved. Maybe this sort of problem is going to

remain one of real conflict for our GP colleagues? I think they have

an understanding of childhood and its needs, child health and child

development which makes the issues of abuse and neglect and the

effects on children pretty clear, so it's not a lack of understanding

of the effects on children. In fact, I'd guess they probably have a

better understanding of child health than wider issues of public

health or the implications of health commissioning. Whether that

amounts to be able to recognise possibkle maltreatment when they see

it, I'm less sure. Kimberley Carlile's GP was confident he'd never

seen a case in all his years of medical practice.

GPs don't have the same type of one to one relationship with

patients, families & communities they used to have. We're not in

Tannochbrae anymore. Most of the practice team I've been registered

with for 10 years would pass me in the street without a flicker of

recognition on either side. As health visitors, we do have a

different kind of exposure to children and families in their homes

and our contacts are driven by a different agenda from patient

instigated reports of illness. We're obviously servants of the

state, as well as a helpful service. Our contacts aren't just

responsive ones and they don't all take place on surgery premises, so

we get a little bit more of an impression of what's going on in

families & communities. Maybe this kind of work gives us a different

perspective, more child centred?

The US made suspected child abuse cases subject to mandatory

reporting, so doctors there have to to do so. It's a very different

system. I'm not sure how making child protection involvement

mandatory for GPs would work here, but it's an interesting idea.

" " < >

From: Louise <loui_r@...>

Date sent: Mon, 7 May 2012 08:08:28 +0100

Subject: Re: Safeguarding , role of GP

Send reply to:

Hi ,

The problem is indeed complex certainly in practice I feel some GP's

are unsure what their role is in safeguarding.I also feel that

limited value is placed on safeguarding and the need for GP input. If

it were to be part if the QAOF I think it would be quite a different

story. I have only seen a GP once at case conference in 8 years and

that was because I insisted as it was a FI case ! Nothing has changed

, it's incredibly frustrating .

Regards,

Louise

Sent from my iPhone

On 6 May 2012, at 23:37, hwood@... wrote:

I suspect the problem is more than one of communication. GPs are

family doctors and tend to be responsible for parents and children,

which can't be easy if they're asked about sensitive issues like

parentlal mental health, drugs, etc. Things may have changed, but in

all my years of practice, I can't remember a GP ever attending a case

conference on a child although a few would talk to me beforehand

about cases.

Have things changed?

" " <SENATE-

HVSN >

From: Louise <loui_r@...>

Date sent: Sun, 6 May 2012 20:48:53 +0100

Subject: Safeguarding , role of GP

Send reply to:

[ Double-click this line for list subscription options ]

Dear Senators,

I am looking at the Gp role in safeguarding ,is anyone aware of GP's

actively involved in case conferences via Skype or perhaps video

conferencing? There is clearly some difficulty in getting Gp's to

attend conferences yet they are often well placed to make valued

contributions to the process .If anybody is aware of good practice

that might be replicated elsewhere I would love to hear from you.

Regards, Louise (HV) Cambs

Sent from my iPhone

------------------------------------

[Guest guest]

Hi Malcolm,

I couldn't agree more - you do well to remind us of the fundamental

clinical role of general medical practice. Other systems which lack

this essential primary care services cost more and exclude too many

who can't handle waiting half the night in a scary emergency

department or simply haven't the money or insurance to go directly to

a specialist. It's very hard to replace GMS and I don't know a

better model at present.

Trouble is, politicians seem to have decided that a good thing in one

context can be even better in another. I still date this back to

Clive Froggatt & Waldegrave - now there's a couple of names

from the past - and the strange conviction that general medical

practice can probably run the health service. Now it takes 2 weeks

to get a non urgent appointment and a month to sort out a routine

blood test. If you need help out of hours, you encounter a strange

selection of people you never met, who don't know your medical

history and may have a shaky grasp of vernacular English/Welsh. I

never feel especially comfortable with these things.

But... children and the frail elderly do have particular needs from

health care services and and our understanding of these needs has

developed a bit since 1948, so maybe the same type of contract and

the same model of service isn't as good a fit any more?

Interesting to hear such well informed perspectives - this is one of

the

real benefits of Senate on such questions.

" " < >

From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>

Date sent: Mon, 7 May 2012 16:35:21 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

[Guest guest]

Dear ,

Mulling over these things I wonder if you know that at least in the South West of England some GPs on the vocational training course are already undertaking modules of training and study in both GP issues and Public

Health issues.

As things stand there are no progression routes for those GPs who want to continue their interest long term in the GP-Public Health boundary zone. Established Consultants and SPecialists in Public Health are not

- it seems to me - at all interested in this problem at this time because they are all feeling most uncertain about their own professional futures.

But if we are to have GPs on the CCGs and the Health and Well Being BOards with any knowledge, skill or experiance in Public Health and Preventative Medicine then someone within the NHS Community needs to make sure

that funding becomes available for GPs with an interest in Public Health especially the so called psycho-social issues.

With the new funding and confidence that is being built within Health Visiting I believe that those very few GPs with a GP and Public Health interest will greatly appreciate the support of HVs on CCGs and Health

and Well Being BOards to make sure that they have " progession routes " .

Many GP practices seem willing to offer part t time GP salaried positions but none can at the same time offer sessional

Public Health work.

A doctor is left to find those sessions for herself/himself at present - but they do not yet exist.

With HV support they could be brought into being so that this conversation could then continue over time. You will recall that the Local Govt Medical Officer of Health was originally a GP who developed a keen interest

in safeguarding individuals, fasmilies and communities from infectious diseases. Now the big issue is to safeguard people from psycho-social distress and disorders.

Malcolm

From: [ ] On Behalf Of hwood@... [hwood@...]

Sent: 07 May 2012 17:35

Subject: RE: Safeguarding , role of GP

Hi Malcolm,

I couldn't agree more - you do well to remind us of the fundamental

clinical role of general medical practice. Other systems which lack

this essential primary care services cost more and exclude too many

who can't handle waiting half the night in a scary emergency

department or simply haven't the money or insurance to go directly to

a specialist. It's very hard to replace GMS and I don't know a

better model at present.

Trouble is, politicians seem to have decided that a good thing in one

context can be even better in another. I still date this back to

Clive Froggatt & Waldegrave - now there's a couple of names

from the past - and the strange conviction that general medical

practice can probably run the health service. Now it takes 2 weeks

to get a non urgent appointment and a month to sort out a routine

blood test. If you need help out of hours, you encounter a strange

selection of people you never met, who don't know your medical

history and may have a shaky grasp of vernacular English/Welsh. I

never feel especially comfortable with these things.

But... children and the frail elderly do have particular needs from

health care services and and our understanding of these needs has

developed a bit since 1948, so maybe the same type of contract and

the same model of service isn't as good a fit any more?

Interesting to hear such well informed perspectives - this is one of

the

real benefits of Senate on such questions.

" " < >

From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>

Date sent: Mon, 7 May 2012 16:35:21 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

********************************************************************************************************************

This message may contain confidential information. If you are not the intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can be accessed anywhere

********************************************************************************************************************

[Guest guest]

Hi Malcolm,

The old south west region was always a bit ahead on such things, so

I'm glad they still are. I do agree about the instability in public

health medicine at present, since my former colleagues are saying the

same. But in fairness, it's been a bit of a sluggish show over the

last 10 years, considering how important it is. Apart from the

latest communicable diseases, it did lack a sense of conviction.

I think you're the only GP I've ever heard talk about the public

health role of health visitors. Indeed, GP attachment and the loss

of neighbourhood level caseloads almost abolished it. As long ago as

2004, Neil Brocklehurst thought that HVs had few relevant public

health skills anymore [brocklehurst N (2004) Is health visiting

`fully engaged´ in its own future well-being? Community practitioner

2004; 77, 6: 214-218]. If this is true, both HVs and GPs could be

lagging a bit and the lack of facilities to develop seems to me to

apply to both. Here's a chance for some economies of scale together

with team development.

Snag is, given the insane succession of NHS revolutions and the

gentler pace of academic developments, how does this work?

PS MoHs were fascinating. I've read some of their old public health

reports in archives and they were a lot more interesting & relevant

than some of the turgid stuff we had at PCT board meetings. They

also provided a district wide perspective within local authorities

and pulled in issues of poor housing, local facilities, unemployment

and deprivation rather than just counting stiffs and sickies. You

can see how it worked and why it had to go if you wanted to blame

individuals for their own ill health...

" " < >

From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>

Date sent: Tue, 8 May 2012 07:38:36 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

Dear ,

Mulling over these things I wonder if you know that at least in the

South West of England some GPs on the vocational training course are

already undertaking modules of training and study in both GP issues

and Public Health issues.

As things stand there are no progression routes for those GPs who

want to continue their interest long term in the GP-Public Health

boundary zone. Established Consultants and SPecialists in Public

Health are not - it seems to me - at all interested in this problem

at this time because they are all feeling most uncertain about their

own professional futures.

But if we are to have GPs on the CCGs and the Health and Well Being

BOards with any knowledge, skill or experiance in Public Health and

Preventative Medicine then someone within the NHS Community needs to

make sure that funding becomes available for GPs with an interest in

Public Health especially the so called psycho-social issues.

With the new funding and confidence that is being built within

Health Visiting I believe thatthose very few GPs with a GPand

Public Health interest will greatly appreciate the support of HVs on

CCGs and Health and Well Being BOards to make sure that they have

" progession routes " .

Many GP practices seem willing to offer part t time GP salaried

positions but none can at the same time offer sessional

Public Health work.

A doctor is left to findthose sessionsfor herself/himself at

present - but they do not yet exist.

With HV support they could be brought into being so that this

conversation could then continue over time. You will recall that

the Local Govt Medical Officer of Health was originally a GP who

developed a keen interest in safeguarding individuals, fasmilies and

communities from infectious diseases. Nowthe big issue is to

safeguard people from psycho-social distress and disorders.

Malcolm

From: [ ] On

Behalf Of hwood@... [hwood@...]

Sent: 07 May 2012 17:35

Subject: RE: Safeguarding , role of GP

Hi Malcolm,

I couldn't agree more - you do well to remind us of the fundamental

clinical role of general medical practice. Other systems which lack

this essential primary care services cost more and exclude too many

who can't handle waiting half the night in a scary emergency

department or simply haven't the money or insurance to go directly to

a specialist. It's very hard to replace GMS and I don't know a

better model at present.

Trouble is, politicians seem to have decided that a good thing in one

context can be even better in another. I still date this back to

Clive Froggatt & Waldegrave - now there's a couple of names

from the past - and the strange conviction that general medical

practice can probably run the health service. Now it takes 2 weeks

to get a non urgent appointment and a month to sort out a routine

blood test. If you need help out of hours, you encounter a strange

selection of people you never met, who don't know your medical

history and may have a shaky grasp of vernacular English/Welsh. I

never feel especially comfortable with these things.

But... children and the frail elderly do have particular needs from

health care services and and our understanding of these needs has

developed a bit since 1948, so maybe the same type of contract and

the same model of service isn't as good a fit any more?

Interesting to hear such well informed perspectives - this is one of

the

real benefits of Senate on such questions.

" " < >

From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>

Date sent: Mon, 7 May 2012 16:35:21 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

**********************************************************************

**********************************************

This message may contain confidential information. If you are not the

intended recipient please inform the

sender that you have received the message in error before deleting it.

Please do not disclose, copy or distribute information in this e-mail

or take any action in reliance on its contents:

to do so is strictly prohibited and may be unlawful.

Thank you for your co-operation.

NHSmail is the secure email and directory service available for all

NHS staff in England and Scotland

NHSmail is approved for exchanging patient data and other sensitive

information with NHSmail and GSi recipients

NHSmail provides an email address for your career in the NHS and can

be accessed anywhere

**********************************************************************

**********************************************

[Guest guest]

Hi ,

So much to think about .

I hope this attachment helps HVs to see just how much we need to support and encourage those few GPs

who are trying to develop joint GP and Public Heath roles.

Best wishes

Malcolm

From: [ ] On Behalf Of hwood@... [hwood@...]

Sent: 08 May 2012 10:52

Subject: RE: Safeguarding , role of GP

Hi Malcolm,

The old south west region was always a bit ahead on such things, so

I'm glad they still are. I do agree about the instability in public

health medicine at present, since my former colleagues are saying the

same. But in fairness, it's been a bit of a sluggish show over the

last 10 years, considering how important it is. Apart from the

latest communicable diseases, it did lack a sense of conviction.

I think you're the only GP I've ever heard talk about the public

health role of health visitors. Indeed, GP attachment and the loss

of neighbourhood level caseloads almost abolished it. As long ago as

2004, Neil Brocklehurst thought that HVs had few relevant public

health skills anymore [brocklehurst N (2004) Is health visiting

`fully engaged´ in its own future well-being? Community practitioner

2004; 77, 6: 214-218]. If this is true, both HVs and GPs could be

lagging a bit and the lack of facilities to develop seems to me to

apply to both. Here's a chance for some economies of scale together

with team development.

Snag is, given the insane succession of NHS revolutions and the

gentler pace of academic developments, how does this work?

PS MoHs were fascinating. I've read some of their old public health

reports in archives and they were a lot more interesting & relevant

than some of the turgid stuff we had at PCT board meetings. They

also provided a district wide perspective within local authorities

and pulled in issues of poor housing, local facilities, unemployment

and deprivation rather than just counting stiffs and sickies. You

can see how it worked and why it had to go if you wanted to blame

individuals for their own ill health...

" " < >

From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>

Date sent: Tue, 8 May 2012 07:38:36 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

Dear ,

Mulling over these things I wonder if you know that at least in the

South West of England some GPs on the vocational training course are

already undertaking modules of training and study in both GP issues

and Public Health issues.

As things stand there are no progression routes for those GPs who

want to continue their interest long term in the GP-Public Health

boundary zone. Established Consultants and SPecialists in Public

Health are not - it seems to me - at all interested in this problem

at this time because they are all feeling most uncertain about their

own professional futures.

But if we are to have GPs on the CCGs and the Health and Well Being

BOards with any knowledge, skill or experiance in Public Health and

Preventative Medicine then someone within the NHS Community needs to

make sure that funding becomes available for GPs with an interest in

Public Health especially the so called psycho-social issues.

With the new funding and confidence that is being built within

Health Visiting I believe thatthose very few GPs with a GPand

Public Health interest will greatly appreciate the support of HVs on

CCGs and Health and Well Being BOards to make sure that they have

" progession routes " .

Many GP practices seem willing to offer part t time GP salaried

positions but none can at the same time offer sessional

Public Health work.

A doctor is left to findthose sessionsfor herself/himself at

present - but they do not yet exist.

With HV support they could be brought into being so that this

conversation could then continue over time. You will recall that

the Local Govt Medical Officer of Health was originally a GP who

developed a keen interest in safeguarding individuals, fasmilies and

communities from infectious diseases. Nowthe big issue is to

safeguard people from psycho-social distress and disorders.

Malcolm

From: [ ] On

Behalf Of hwood@... [hwood@...]

Sent: 07 May 2012 17:35

Subject: RE: Safeguarding , role of GP

Hi Malcolm,

I couldn't agree more - you do well to remind us of the fundamental

clinical role of general medical practice. Other systems which lack

this essential primary care services cost more and exclude too many

who can't handle waiting half the night in a scary emergency

department or simply haven't the money or insurance to go directly to

a specialist. It's very hard to replace GMS and I don't know a

better model at present.

Trouble is, politicians seem to have decided that a good thing in one

context can be even better in another. I still date this back to

Clive Froggatt & Waldegrave - now there's a couple of names

from the past - and the strange conviction that general medical

practice can probably run the health service. Now it takes 2 weeks

to get a non urgent appointment and a month to sort out a routine

blood test. If you need help out of hours, you encounter a strange

selection of people you never met, who don't know your medical

history and may have a shaky grasp of vernacular English/Welsh. I

never feel especially comfortable with these things.

But... children and the frail elderly do have particular needs from

health care services and and our understanding of these needs has

developed a bit since 1948, so maybe the same type of contract and

the same model of service isn't as good a fit any more?

Interesting to hear such well informed perspectives - this is one of

the

real benefits of Senate on such questions.

" " < >

From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>

Date sent: Mon, 7 May 2012 16:35:21 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

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Trust_Publication__revised[1].doc

[Guest guest]

Hello I may be moving away from the GP/public health thread here but staying with child protection, there are many papers in the child protection literature placing child protection under public health services, which is the case in Wales. The Safeguarding for South Wales is managed by a health visitor with local team leaders and well planned co-ordination of training and service. I also am aware (although now retired) of far from sluggish public health issues with effective lobbying for drug and alcohol policies,  smoking cessation, healthy eating and obesity. BTW the RCPCH run Safeguarding Children and Young people e learning courses covering many aspects of child protection for primary and secondary care developed in line with intercollegiate safeguarding competancies. These very accessible courses are aimed at a variety of professional audiences from non clinical such as anyone concerned through to GPs, A & E staff and so on. The Open University degree in Health and Social Care, and its many non degree linked modules and courses, provides plenty of opportunities for studying social medicine in all its complexities http://www3.open.ac.uk/study/undergraduate/qualification/health-and-social-care/public-health/index.htm. It was actually attending a Society of Social Medicine Conference with my husband  long ago which opened my eyes to the whole breadth of health and social care, and if nothing else its match with health visiting for embodying principles akin to those of health visiting.The boundaries of health visiting are broad. That the role varies in its ability to work across many fronts according to contexts of time, regional and national variation, new knowledge and political policies is the same for many professions. My view is that it is up to individuals to practice according to their professional best, not some dogma imposed by others. From: [mailto: ] On Behalf Of hwood@...Sent: 08 May 2012 10:52 Subject: RE: Safeguarding , role of GP Hi Malcolm,The old south west region was always a bit ahead on such things, so I'm glad they still are. I do agree about the instability in public health medicine at present, since my former colleagues are saying the same. But in fairness, it's been a bit of a sluggish show over the last 10 years, considering how important it is. Apart from the latest communicable diseases, it did lack a sense of conviction.I think you're the only GP I've ever heard talk about the public health role of health visitors. Indeed, GP attachment and the loss of neighbourhood level caseloads almost abolished it. As long ago as 2004, Neil Brocklehurst thought that HVs had few relevant public health skills anymore [brocklehurst N (2004) Is health visiting `fully engaged´ in its own future well-being? Community practitioner 2004; 77, 6: 214-218]. If this is true, both HVs and GPs could be lagging a bit and the lack of facilities to develop seems to me to apply to both. Here's a chance for some economies of scale together with team development.Snag is, given the insane succession of NHS revolutions and the gentler pace of academic developments, how does this work? PS MoHs were fascinating. I've read some of their old public health reports in archives and they were a lot more interesting & relevant than some of the turgid stuff we had at PCT board meetings. They also provided a district wide perspective within local authorities and pulled in issues of poor housing, local facilities, unemployment and deprivation rather than just counting stiffs and sickies. You can see how it worked and why it had to go if you wanted to blame individuals for their own ill health... " " < >From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>Date sent: Tue, 8 May 2012 07:38:36 +0100Subject: RE: Safeguarding , role of GPSend reply to: Dear , Mulling over these things I wonder if you know that at least in the South West of England some GPs on the vocational training course are already undertaking modules of training and study in both GP issues and Public Health issues. As things stand there are no progression routes for those GPs who want to continue their interest long term in the GP-Public Health boundary zone. Established Consultants and SPecialists in Public Health are not - it seems to me - at all interested in this problem at this time because they are all feeling most uncertain about their own professional futures. But if we are to have GPs on the CCGs and the Health and Well Being BOards with any knowledge, skill or experiance in Public Health and Preventative Medicine then someone within the NHS Community needs to make sure that funding becomes available for GPs with an interest in Public Health especially the so called psycho-social issues. With the new funding and confidence that is being built within Health Visiting I believe thatthose very few GPs with a GPand Public Health interest will greatly appreciate the support of HVs on CCGs and Health and Well Being BOards to make sure that they have " progession routes " . Many GP practices seem willing to offer part t time GP salaried positions but none can at the same time offer sessional Public Health work. A doctor is left to findthose sessionsfor herself/himself at present - but they do not yet exist. With HV support they could be brought into being so that this conversation could then continue over time. You will recall that the Local Govt Medical Officer of Health was originally a GP who developed a keen interest in safeguarding individuals, fasmilies and communities from infectious diseases. Nowthe big issue is to safeguard people from psycho-social distress and disorders. Malcolm From: [ ] On Behalf Of hwood@... [hwood@...]Sent: 07 May 2012 17:35 Subject: RE: Safeguarding , role of GPHi Malcolm,I couldn't agree more - you do well to remind us of the fundamentalclinical role of general medical practice. Other systems which lackthis essential primary care services cost more and exclude too manywho can't handle waiting half the night in a scary emergencydepartment or simply haven't the money or insurance to go directly toa specialist. It's very hard to replace GMS and I don't know abetter model at present.Trouble is, politicians seem to have decided that a good thing in onecontext can be even better in another. I still date this back toClive Froggatt & Waldegrave - now there's a couple of namesfrom the past - and the strange conviction that general medicalpractice can probably run the health service. Now it takes 2 weeksto get a non urgent appointment and a month to sort out a routineblood test. If you need help out of hours, you encounter a strangeselection of people you never met, who don't know your medicalhistory and may have a shaky grasp of vernacular English/Welsh. Inever feel especially comfortable with these things.But... children and the frail elderly do have particular needs fromhealth care services and and our understanding of these needs hasdeveloped a bit since 1948, so maybe the same type of contract andthe same model of service isn't as good a fit any more?Interesting to hear such well informed perspectives - this is one ofthereal benefits of Senate on such questions. " " < >From: " Rigler Malcolm (NORTH SOMERSET PCT) " <m.rigler@...>Date sent: Mon, 7 May 2012 16:35:21 +0100Subject: RE: Safeguarding , role of GPSend reply to: ********************************************************************************************************************This message may contain confidential information. If you are not the intended recipient please inform thesender that you have received the message in error before deleting it.Please do not disclose, copy or distribute information in this e-mail or take any action in reliance on its contents:to do so is strictly prohibited and may be unlawful.Thank you for your co-operation.NHSmail is the secure email and directory service available for all NHS staff in England and ScotlandNHSmail is approved for exchanging patient data and other sensitive information with NHSmail and GSi recipientsNHSmail provides an email address for your career in the NHS and can be accessed anywhere********************************************************************************************************************

[Guest guest]

Thanks ! These are both great sources. The RCPCH stuff is

actually not massively expensive when you compare it with some of the

fluffier stuff advertised in HSJ, is it?

Wales does do these things rather constructively. I've been re-

reading your work on prevention of head injury in babies and wondered

how it fitted with some of the work on collecting A & E injury data on

children in Cardiff and beyond. Are you able to point to some recent

updates?

I agree with your statement : 'The boundaries of health visiting are

broad. That the role varies in its ability to work across many fronts

according to contexts of time, regional and national variation, new

knowledge and political policies is the same for many professions. My

view is that it is up to individuals to practice according to their

professional best, not some dogma imposed by others.' It reminds me

of that bit in 1956 on report that descibed us as 'a willing

horse on whose back every man will lay a saddle' . High time we had

some proper professional institute or college, IMO.

< >

From: " Coles " <lisa@...>

Date sent: Tue, 8 May 2012 11:44:50 +0100

Subject: RE: Safeguarding , role of GP

Send reply to:

Hello

I may be moving away from the GP/public health thread here but

staying with child protection, there are many papers in the child

protection literature placing child protection under public health

services, which is the case in Wales.

The Safeguarding for South Wales is managed by a health visitor with

local team leaders and well planned co-ordination of training and

service. I also am aware (although now retired) of far from sluggish

public health issues with effective lobbying for drug and alcohol

policies, smoking cessation, healthy eating and obesity.

BTW the RCPCH run Safeguarding Children and Young people e learning

courses covering many aspects of child protection for primary and

secondary care developed in line with intercollegiate safeguarding

competancies. These very accessible courses are aimed at a variety of

professional audiences from non clinical such as anyone concerned

through to GPs, A & E staff and so on.

The Open University degree in Health and Social Care, and its many

non degree linked modules and courses, provides

[Guest guest]

Hi I think the name you need to enquire about for the AWISS child injury data is Professor Ronan Lyons r.a.lyons@...At the time I left Cardiff University Child Health Dept. The Centre for the Development of Complex Interventions for Public Health ImpRovement, DECIPHer, under Professor Lawrence was just being formed and some of our work moved into that http://www.decipher.uk.net/ Ronan Lyons is there under People. DECIPHer is a UKCRC Public Health Research Centre of Excellence. It gives an idea of the type of public health work going on at present. I copied this:DECIPHer brings together leading experts from a range of disciplines to tackle public health issues such as diet and nutrition, physical activity; and alcohol, tobacco and drugs, with a particular focus on developing and evaluating multi-level interventions that will have an impact on the health and well-being of children and young people. The Centre engages strongly with policy, practice and public user communities as our stakeholders to translate the research results into practical outcomes. I copied this from Swansea University website: Professor Ronan Lyons Specialist Subjects: Health Informatics; Public Health; Cohorts; Complex Interventions; Injuries http://www.swan.ac.uk/staff/academic/medicine/lyonsr/Within the field of injury epidemiology and prevention he developed the All Wales Injury Surveillance System (AWISS) and has been involved in a number of EU funded projects, including, currently, the JAMIE project (Joint Action on Monitoring Injuries in Europe). He is a scientific advisor to the EU TACTICS project (Tools to Address Childhood Trauma, Injury and Children's Safety), the NIHR programme grant " Developing new ways of measuring the impact of ambulance service care " led by Siriwardena (East Midlands and Sheffield), and the Canadian Institute of Health Research's Team in Child and Youth Injury Prevention " Strategic Teams in Applied Injury Research " , led by Pike (University of British Colombia).All the best From: [mailto: ] On Behalf Of hwood@...Sent: 08 May 2012 12:16 Subject: RE: Safeguarding , role of GP Thanks ! These are both great sources. The RCPCH stuff is actually not massively expensive when you compare it with some of the fluffier stuff advertised in HSJ, is it?Wales does do these things rather constructively. I've been re-reading your work on prevention of head injury in babies and wondered how it fitted with some of the work on collecting A & E injury data on children in Cardiff and beyond. Are you able to point to some recent updates?I agree with your statement : 'The boundaries of health visiting are broad. That the role varies in its ability to work across many fronts according to contexts of time, regional and national variation, new knowledge and political policies is the same for many professions. My view is that it is up to individuals to practice according to their professional best, not some dogma imposed by others.' It reminds me of that bit in 1956 on report that descibed us as 'a willing horse on whose back every man will lay a saddle' . High time we had some proper professional institute or college, IMO.< >From: " Coles " <lisa@...>Date sent: Tue, 8 May 2012 11:44:50 +0100Subject: RE: Safeguarding , role of GPSend reply to: Hello I may be moving away from the GP/public health thread here but staying with child protection, there are many papers in the child protection literature placing child protection under public health services, which is the case in Wales.The Safeguarding for South Wales is managed by a health visitor with local team leaders and well planned co-ordination of training and service. I also am aware (although now retired) of far from sluggish public health issues with effective lobbying for drug and alcohol policies, smoking cessation, healthy eating and obesity.BTW the RCPCH run Safeguarding Children and Young people e learning courses covering many aspects of child protection for primary and secondary care developed in line with intercollegiate safeguarding competancies. These very accessible courses are aimed at a variety of professional audiences from non clinical such as anyone concerned through to GPs, A & E staff and so on.The Open University degree in Health and Social Care, and its many non degree linked modules and courses, provides