Time for GPs to ‘open the door' to children and young people

Although GPs are the first port of call for most people with health concerns, studies have consistently revealed a degree of unease among young people about approaching them.

Indeed, more than a third of young people surveyed by the UK Youth Parliament said they would not consult their GP about particular issues such as sexual health, mental health and weight.

A report by the National Children’s Bureau, Opening the door to better healthcare, has added to the demand for change. It calls for GPs to be better trained to work with children; for children and young people’s experiences to be taken into account when measuring GP performance; and for accessibility for children to be improved (see box).

Here, three experts outline what they believe must happen.

Adolescent health view
Emma Rigby

"The situation needs to be ­improved, both for young people and for GPs. Research shows young people have the shortest consultations and are typically the least ­satisfied group with the consultation. Conversely, GPs report that dealing with adolescent patients takes time, and they often have nowhere to refer those who need counselling for issues such as self-harm.

"These problems need innovative solutions. As part of AYPH’s GP Champions for Youth Health project, 10 sites around England are looking at how they can combine GP services and voluntary sector information, advice and counselling services to improve young people’s health services. Ideas including GP-led drop-in sessions and new referral pathways for young people, especially around mental health, are being tested. Young people’s views are central to the project, and early feedback shows they have plenty of ideas on how GP services can be improved.

"Services for young people need to be flexible. Young people want to be able to book an appointment online because they may not have enough phone credit to ring at a certain time. They also want to be able to engage a health professional in the evening, at the weekend and in convenient locations such as a youth club, school or college.

"The new NHS bodies are perfectly placed to commission innovative GP services, youth advice and counselling services to improve young people’s health. There is a strong rationale for improving care for this age group. Adolescence is a critical time, with higher levels of mortality than for younger children, the start of risk-taking behaviour and the point when many serious long-term conditions are first seen. The effects of poor health in adolescence last a lifetime, but, conversely, the foundations of good health can also be laid."

Emma Rigby is chief executive of the Association for Young People’s Health (AYPH)

Voluntary sector view
Keith Clements

"When looking at how GPs can do a better job for children and young people, it is important to remember that some of the most vital improvements are hindered by the systems within which they work, rather than the actions of GPs themselves.

"Enshrining “out-of-hours” services in regulations, improving GPs’ paediatric training and improving the representation of children and young people in national patient surveys are key priorities. There are, however, some steps that GPs are well placed to take themselves.

"Some GPs are experts in meeting children’s needs, and those who could benefit from advice on good practice would understandably find it easier to digest if it came from those with experience of being a GP in the current climate. The coming together of GPs who have a particular interest in child health, to form a national good practice network, would be a useful step.

"It is vital that all staff who work with children take into account young people’s unique needs in terms of communication, and involve them in decisions about their care.

"GPs should consider how they are supporting young people to develop a more active role in their health as they move towards adulthood, and bring practice nurses and other staff into the process where necessary.

"It is an obvious win for GPs to be able to confer with specialists based in hospitals to check their opinion on less serious cases, without referring the patients for hospital treatment. This would benefit the children and let hospitals concentrate on caring for those who need them most.

"There are potential systematic barriers here of course, and the onus is as much on other professionals to make themselves amenable. Practices could nevertheless have a strategy, with a medical and/or nursing lead being tasked with building and maintaining those bridges."

Keith Clements is policy officer at the National Children’s Bureau

GP view
Dr Clare Gerada

"Unlike in many other countries, most care for children and young people is provided in general practice, by general practitioners and general practice nurses rather than by specialist paediatricians in hospitals – and rightly so. This allows young people to be treated in the context of their families and ensures continuity beyond childhood and adolescence.

"However, although a quarter of a GP’s patients are under 19 years of age, only half of our trainee GPs have the opportunity to undertake a specialist paediatric placement during their training.