The government is currently consulting on a 10-year health plan for England. Central planks include moving care from hospitals to communities, and focusing on prevention, not treatment. Reinforcing primary care seems an obvious route to both and Wes Streeting’s first ministerial visit as Health Secretary was to a GP surgery.
With much discussion around the potential for “youth hubs” to address emerging mental health problems, family support, employment assistance, or violence prevention, primary care offers a pre-existing, trusted and local offer that could be built on.
However, young people often express less satisfaction with primary care than other age groups. They report particular barriers to accessing their GPs, including difficulties in fitting healthcare around education, challenges navigating systems for booking appointments, and misunderstandings around privacy and consent.
In addition, the system does not incentivise youth health. Primary care training often does not cover the age group and GPs can lack expertise in mental health problems in adolescence. The quality and outcomes framework, which rewards achievements in primary care practices in England, has very few indicators that relate directly to improvement in youth health.
Primary care for adolescents requires a different approach to that for younger children or older adults. Engaging with young people as they transition to independent lives and self-care is critical for setting a pathway for future health.
The Well Centre in Lambeth and Wandsworth provides a model for how things could be improved and illustrates what some of the benefits can be. Led by GP Dr Stephanie Lamb, and established in 2011, the Well Centre is a free, confidential primary care service for 11- to 21-year-olds. Around 1,000 young people access the service annually.
A bespoke, youth-friendly assessment – “teen health check” – by a GP is followed by a flexible service offered by either the GP, or other practitioners such as youth workers or mental health practitioners, as well as through liaison with other services. This includes drop-in sessions, hours that work around college, and outreach in community settings.
Evaluation outcomes
In 2024, the Association for Young People’s Health undertook an evaluation of the Well Centre model to describe the service’s delivery model and to begin to unpick indicators of impact. It was clear that this is a hugely valued service, particularly drawing in young people from ethnic minority groups and those living in areas of deprivation. Most present with forms of anxiety or depression, and Well Centre staff identify high rates of trauma and adverse childhood experiences in the client histories.
Drawing on interviews and service audit data, a range of positive impacts can be identified including positive experiences for young people (see box) and improved health. There was also evidence of better communication between young people and practitioners, improved practitioner knowledge and confidence, enhanced access to services, good use of onward referral and diversion from crisis services.
Scaling the model
The next step is to work out how to spread and scale the Well Centre model (see box). The major challenges are securing sustainable funding, tailoring services to fit into the local context, and providing resources, training and support for people wanting to adopt the framework. The recently established Well Centre Charity is looking at these challenges in more detail and working with pilot sites.
Investing in young people’s health is critical for securing what the World Health Organisation calls a “triple dividend” – improvements to their health now, their future health as adults, and the health of their own children at a later stage. Taking a holistic, public health approach is likely to be the most fruitful way forward, rather than siloed responses that only target, for example, mental health or problematic behaviour. Primary care offers a pragmatic framework for building a better offer for young people.
SCALING UP AND SPREADING THE WELL CENTRE APPROACH
Last year, the Well Centre Charity was formed to lead work on spreading and scaling the Well Centre’s approach to youth-friendly primary care. Led by chief executive John Poyton (pictured)and working in partnership with the NHS Well Centre service, the charity will offer support and expertise around the development of adolescent health hubs and youth-friendly primary care services.
This will include help with initial service planning, support for youth health champions, enhancing skills of existing clinical and non-clinical staff within the practice, and providing access to resources including case studies, training material, information around referral pathways, and support for advocacy and building the business case. The charity will also have a role in fostering a network or virtual community of people involved in improving the primary care offer to young people.
More at www.wellcentrecharity.org
YOUNG PEOPLE'S VIEWS
- “The staff were exceptionally nice and friendly. I am quite shy but I still felt very comfortable and welcomed.”
- “It helped me understand my emotions and made me a person I’m proud to be. I am much happier than I was six months ago.”
- “Sessions have made me think differently about my mental health and the effect certain experiences have had on me. Overall, it has been beneficial coming.”
- “[She] was really good at making the space feel welcoming and safe to talk and was understanding about what I felt.”
