General practitioner provision of preventive child health care: analysis of routine consultation data.

Rachael Wood,Philip Wilson

doi:10.1186/1471-2296-13-73

Abstract

BackgroundGPs contribute to preventive child health care in various ways, including provision of child health surveillance (CHS) reviews, opportunistic preventive care, and more intensive support to vulnerable children. The number of CHS reviews offered in Scotland was reduced from 2005. This study aimed to quantify GPs’ provision of different types of preventive care to pre-school children before and after the changes to the CHS system.MethodsGP consultation rates with children aged 0–4 years were examined for the 2½ years before and after the changes to the CHS system using routinely available data from 30 practices in Scotland. Consultations for CHS reviews; other aspects of preventive care; and all reasons were considered.ResultsPrior to the changes to the CHS system, GPs often contributed to CHS reviews at 6–8 weeks and 8–9 and 39–42 months. Following the changes, GP provision of the 6–8 week review continued but other reviews essentially ceased. Few additional consultations with pre-school children are recorded as involving other aspects of preventive care, and the changes to CHS have had no impact on this. In the 2½ years before and after the changes, consultations recorded as involving any form of preventive care accounted for 11% and 7.5% respectively of all consultations with children aged 0–4 years, with the decline due to reductions in CHS reviews.ConclusionsEffective preventive care through the early years can help children secure good health and developmental outcomes. GPs are well placed to contribute to the provision of such care. Consultations focused on preventive care form a small minority of GPs’ contacts with pre-school children, however, particularly since the reduction in the number of CHS reviews.

Highlights

General Practitioner (GP) contribute to preventive child health care in various ways, including provision of child health surveillance (CHS) reviews, opportunistic preventive care, and more intensive support to vulnerable children
There were essentially no GP consultations coded as 21–24 month reviews after the changes to CHS despite the availability of the selective 24 month review during this period which would have been identified by the codes used
Since 2005, GPs have had minimal involvement in the selective child health reviews provided by Health Visitors to vulnerable toddlers: this raises questions about the adequacy of developmental and physical health assessments being provided to this age group

Summary

Introduction

GPs contribute to preventive child health care in various ways, including provision of child health surveillance (CHS) reviews, opportunistic preventive care, and more intensive support to vulnerable children. The UK National Health Service (NHS) offers a core service of proactive care through the universal child health programme (CHP). This comprises certain screening procedures; routine childhood vaccinations; surveillance of children’s growth and development; and provision of age appropriate health promotion and parenting advice [7]. The surveillance and advice components take place in child health surveillance (CHS) reviews offered to all children at specified ages. Practice nurses (PNs) and health visitors (HVs) usually have lead responsibility for delivery of vaccinations and child health surveillance reviews respectively but general practitioners (GPs) provide substantial input to delivery of the universal elements of the CHP. GPs retain responsibility for provision of vaccinations, and in almost all practices GPs provide at least some elements of the CHS reviews

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