An editorial in this weeks BMJ highlights several causes for concern regarding children's health in general practice in Britain. Once greatly admired, the British model of general practice raises concern over the future of children's health.
Professor David Hall, Community Paediatrics, Institute of General Practice and Primary Care, Northern General Hospital, Sheffield, UK, sees many causes for concern.
Out of hours arrangements may encourage parents to bypass primary care and seek emergency care in hospitals.
General practitioners have yet to take on a major role in managing chronic disorders, many of which persist into adult life;
Health promotion for teenagers is also problematic because of concerns about the privacy and confidentiality offered by their local general practice, despite many practices having sought to reassure young people by establishing special teenage clinics.
He believes that the new contract does not encourage general practitioners to focus on children's care. It offers additional remuneration based on a points system, but child health surveillance gets just six points. In contrast, cervical screening can get 22 points, mental health work 41 points, diabetes 99, and heart disease 121.This structure encourages general practitioners to focus on and develop special interests in adult health and chronic disease.
General practice is in a dilemma; to continue to provide good health care for children and young people, general practitioners will need appropriate training and remuneration to provide quality child healthcare for the 21st century and opportunities to develop special interests in various aspects of child and adolescent health.
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