For instance, new out of hours arrangements may encourage parents to bypass primary care and seek emergency care in hospitals, while general practitioners have yet to take on a major role in managing chronic disorders, many of which persist into adult life, writes Professor David Hall.
Health promotion for teenagers is also problematic because of concerns about the privacy and confidentiality offered by their local general practice, despite many practices having sought to reassure young people by establishing special teenage clinics.
He believes that the new contract does not encourage general practitioners to focus on children's care. It offers additional remuneration based on a points system, but child health surveillance gets just six points. In contrast, cervical screening can get 22 points, mental health work 41 points, diabetes 99, and heart disease 121.
This structure may encourage general practitioners to focus on and develop special interests in adult health and chronic disease, he says.
General practice is at a crossroads. To maintain their place as the main providers of health care for children and young people, general practitioners will need appropriate training and remuneration for providing a practice based quality child health service for the 21st century and opportunities to develop special interests in various aspects of child and adolescent health, he concludes.
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
24-Feb-2005