Community child health in crisis

M Bannon

doi:10.1136/adc.2003.042093

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Community child health in crisis

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Paediatrics is community paediatrics
Tony Waterston
Published on: 9 January 2022
Community Paediatrics
Andrew N Williams
Published on: 9 January 2022
Community paediatricians
Somnath Banerjee
Published on: 9 January 2022

Published on: 9 January 2022
Paediatrics is community paediatrics
- Tony Waterston, Consultant Paediatrician
Dear Editor,
Drs. Bannon and Mather give a gloomy prognosis for the future of community paediatrics which is not new: many of the same views were expressed in the RCPCH review of the field by Craft et al. However there are a number of reasons for being more positive and presenting a clear vision.
First, we should stop saying that community paediatrics is difficult to explain. I say that 'I practic...
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Dear Editor,
Drs. Bannon and Mather give a gloomy prognosis for the future of community paediatrics which is not new: many of the same views were expressed in the RCPCH review of the field by Craft et al. However there are a number of reasons for being more positive and presenting a clear vision.
First, we should stop saying that community paediatrics is difficult to explain. I say that 'I practice holistic general paediatrics'. This means simply caring for the whole child; this should be the general paediatrics of the future, applicable in or out of hospital. I do not consider community paediatrics to be a specialty: it is holistic general paediatrics. Hence all trainees need to imbibe its philosophy, including the incorporation of a mental health and a population perspective. There are specialties of community paediatrics which would be seen in the same way as organ-based specialties.
Second, we have to get the training right - this means the training of all paediatricians. We can do this by developing a holistic approach in SpR training including mental health, disability, social paediatrics, advocacy and a population perspective. This can be done and there are many good examples in the UK, as well as in other countries. For example, the following are constituents of training programmes supported by the American Academy of Pediatrics: a continuity clinic where the trainee gives service over a two year period - to understand the continuity of health care. A well organised training module on community -based services. An advocacy project, in which the trainee engages with a real problem of health care and seeks to resolve it.
These and other proposals are being developed by members of the Equity Project between the RCPCH and the AAP. We can make the model for the paediatrician of the future a holistic paediatrician: if we look forward rather than back.
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Conflict of Interest:
None declared.
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Published on: 9 January 2022
Community Paediatrics
- Andrew N Williams, consultant community paediatrician
Dear Editor
Dr Mather’s and Dr Bannon’s articles are timely reminders of the crisis facing community paediatrics today. When I am asked what I do as a community paediatrician I say that “I generally endeavour to manage children with physical, behavioural and emotional difficulties in their locality rather than them having to come to see me in a hospital.” If then Dr Bannon’s layperson wants a sentence or two m...
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Dear Editor
Dr Mather’s and Dr Bannon’s articles are timely reminders of the crisis facing community paediatrics today. When I am asked what I do as a community paediatrician I say that “I generally endeavour to manage children with physical, behavioural and emotional difficulties in their locality rather than them having to come to see me in a hospital.” If then Dr Bannon’s layperson wants a sentence or two more, I mention physical disability, learning difficulty including autism and epilepsy as well as a role and duty in management of child abuse and coordinating childhood immunisations.
As well as a poor image, the spectre of child protection is now the most significant and growing problem facing community child health.
Most paediatricians, I assume, did not embark upon a career choice through a wish to sacrifice themselves or their families for the sake of an abused child or abused children. But this is the stark reality of those paediatricians who are dealing with child protection. Frankly you’re damned if you do and damned if you don’t.
It is however a very different matter if you are seeing the occasional abused child within your clinical practice than routinely seeing suspected cases as part of your designated role. No one wants for understandable reasons to put themselves in the firing line.
It is human nature after all to defer or avoid an unpleasant experience by taking an alternative path. Hence numbers of applicants for community child health posts are falling and child protection posts remain unfilled. This is very bad news indeed for abused children who should be protected. It is sadly inevitable that this now serious deficiency will contribute to further child protection tragedies. More child deaths lead to more enquiries and media driven witch hunts against the “blamed” professionals involved. All of which exacerbate the situation.
I believe the Government must take responsibility for this problem as it has the final responsibility for the welfare of its citizens. My feeling is that to deal with this problem it will have to set up some form of nationally coordinated, local medical child protection panels to diagnose abuse. It would not necessarily have to include only consultant community paediatricians, other experienced paediatricians, police surgeons and child protection nurses could also be included.
Child protection opinions are given by that panel and the panel takes full responsibility for the diagnosis rather than a single person. To constitute and run such panels so that they could deal promptly with suspected child protection cases would of course cost significant resources, which perhaps should be directly Government funded thereby taking pressures off cash strapped PCT’s. Furthermore, it is within the power of the law, if necessary, to grant the protection of anonymity for the panel members involved, if child health professionals are going to be prepared to undertake it.
I believe that community paediatrics is both noble and necessary for child health. It does of course involve advocacy and social paediatrics but we delude ourselves that if we trumpet these as our main role which is within a medical context the assessment, diagnosis and management of children. It is unlikely ever to be perceived as exciting in the public’s mind nor would some of us wish it to be.
As a general fact of life, respect is not given, it is earned. Through our practice and actions we community paediatricians have to both challenge and alter adverse views regarding our professional work.
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Conflict of Interest:
None declared.
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Published on: 9 January 2022
Community paediatricians
- Somnath Banerjee, NHS doctor
Dear Editor,
I was pleasantly surprised with the leading article "Community paediatrics in crisis" by Dr M Mather.
She pointed out in the article the minute details about the work and obstacles of community paediatricians. I always felt that the Royal College of Paediatrics is dominated by the acute hospital paediatricians and super-specialists. Now I wish that our royal college do pay attention and due r...
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Dear Editor,
I was pleasantly surprised with the leading article "Community paediatrics in crisis" by Dr M Mather.
She pointed out in the article the minute details about the work and obstacles of community paediatricians. I always felt that the Royal College of Paediatrics is dominated by the acute hospital paediatricians and super-specialists. Now I wish that our royal college do pay attention and due respect to community paediatricians so that the attitute of hospital peadiatricians is more respectable to these doctors who are responsible for 95% or more of the child population at any given time.
Moreover the present NHS system is unlikely to change in next twenty years where school drop-outs are the managers; controlling the doctors' way of working, but atleast our Royal College may set an example.
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Conflict of Interest:
None declared.
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