Re: Safeguarding , role of GP [1 Attachment]

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What an interesting discussion - thank you, and Malcolm. And thanks for the attachment, Malcolm, about 'learning through illness.' Reminds me of my 20+ year old PhD which flagged up that health visiting is as much/more about education as about nursing, because it is intended to support development (personal and situational), learning, progress. Lots of water under the bridge since then - but still important to avoid health visiting getting pulled too far into the illness/problems/crisis management field: these days child protection crisis management seems to take health visitors away from prevention more than illness management, but it is the same thinking.best wishesOn 8 May 2012, at 11:07, Rigler Malcolm (NORTH SOMERSET PCT) wrote: 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: ********************************************************************** ********************************************** 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. 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