Some aspects of child health care: contacts between children, general practitioners and school doctors

Abstract

Since the Report of the Committee on Child Health Services1 there has been discussion of the child health services from professionals but not from parents. In a survey carried out in 1977 parents were asked about their children's use of the health services and their views about this. The parents' general practitioners were also questioned about children's health care. The children's contact with the services is described, and the relationship between general practitioners and school doctors. A similar survey was carried out in 1964 and changes in children's use of the services over the intervening years are examined. In 1977 nearly all children (91 per cent) were registered with a ‘family doctor’ who also looked after the parent interviewed, and most parents were registered with a doctor who looked after all their children. The concept of a family doctor conflicts with the Court Report's proposal for a specialist paediatrician in primary care. However, nearly a third of parents would prefer a specialist. The idea was not popular with doctors, of whom 81 per cent said they preferred the present system. Three-quarters of the children had seen their general practitioner in 1977, and this proportion had not changed since 1964. The main change was a striking drop in home visits which had its most marked effect on children of pre-school age. Children aged under 5 had a lower consultation rate than in 1964. The overall consultation rate for other age groups had not changed. Similar proportions of children had seen a school doctor in 1977 as in 1964, but communication between the school doctor and general practitioner did not appear to have improved. Parents attended less than half the school medicals and were less likely than in 1964 to discuss with their general practitioner a problem about which the school doctor had offered them advice. The introduction of specialist care might jeopardize vital parts of the primary care system. However, to ensure that relevant information is directed to where it is needed, some integration of health services for children, or of their medical records, seems essential.