Improving child health services in the UK: insights from Europe and their implications for the NHS reforms
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1277 (Published 08 March 2011) Cite this as: BMJ 2011;342:d1277All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
I cannot think of any colleagues who do not share this concern about
Child Health within the current National Health Service reform: "Problems
with children's first access care may not be solved by devolving
commissioning to general practitioners (or private sector proxies)".[1]
Sadly, the Analysis does not mention mental health services for
children (CAMHS) although comparative studies have found young people in
England express higher levels of psychological need than other European
adolescents. The National CAMHS Support Service [2] has recently made a
strong case for 'prioritising children's mental health outcomes'. The
authors of this case also worry that 'while the benefits of intervening
early are not disputed, introducing more early intervention services can
be challenging for commissioners'.[2] In the new funding systems, a key
challenge will be to understand the 'interaction' between mental and
physical health.[3]
The Centre for Quality Improvement at the Royal College of
Psychiatrists has made a generous offer [4] to 'liaise with the Royal
College of Paediatricians' to see if these two vital UK stakeholders can
'learn from each other' in improving the services for our children.
[1] Wolfe I, Cass H, Thompson MJ et al. Improving child health
services in the UK: insights from Europe and their implications for the
NHS reforms. BMJ 2011 342:d1277; doi:10.1136/bmj.d1277
[2] National CAMHS Support Service. Better Mental Health Outcomes for
Children and Young People. 2011 www.chimat.org.uk/camhs/commissioning
(accessed 12 March 2011).
[3] Caan, W. Editorial. Journal of Public Mental Health 2011; 10 (1):
2-3. (in press - March issue)
[4] Worrall A. Re: no health without mental health? Rapid response to
BMJ, 4 January 2011.
Competing interests: I have been advising on public mental health to the All Party Parliamentary Group on suicide prevention and have recently been invited to support a planned group on mental well-being and the "Big Society".
GPs have the future of child health in their hands as never before
Concerns about the competency of GPs to manage health problems in
children are not new, but with the onset of GP commissioning the
requirement to address them is greater than ever. The first step is for
general practice as a profession to recognise the important role is has to
play in the health and welfare of children. The plethora of other
professionals who have, quite rightly, taken on greater activity in this
area (health visitors, midwives, nursery nurses, school nurses etc etc),
and the lack of financial incentives through structures like the Quality
Outcomes Framework, mean that GPs have been less minded to consider the
health of children as they might have been. GPs are well-placed to play a
crucial role in improving the health and welfare of children, but only if
they recognise this opportunity and choose to take it. Choose, because if
they do not consider themselves either able or willing to discharge this
responsibility then they may need to allow others to do so, as seen in
models of care in other European countries referred to in the article. The
response needs to be two-fold:
Firstly the RCGP Childrens Champion needs full support from the
College and from the profession in his drive to develop and promote a
Child Health Strategy that will define what is expected of rank and file
GPs working with children in the 21st century. Without clear leadership it
will be impossible to galvanise a coherent and cohesive response from
general practice to the challenges presented.
Secondly, GP commissioners need to appreciate the extent of the
relative failure of present services to meet the health needs of children,
and to recognise the need to develop the sort of integrated services that
will deliver the improved outcomes seen in other countries. Time is not on
their side. As PCTs seem to been disappearing into the night, the power of
acute foundation trusts rises, raising the spectre not of greater co-
operation and cohesion, but of greater competition and fragmentation. It
falls to fledgling GP consortia to support and develop existing
partnerships to ensure that any progress towards better integration of
services, favoured by many clinicians and professional bodies such as the
RCPCH, is not lost. Equally, GP consortia need to appreciate the complex
but often necessary partnership working required with other agencies in
the childrens workforce. The danger is that whereas improvement takes
time, deterioration may happen rapidly without a broad strategic
perspective on commissioning.
This article accurately presents the unsatisfactory present situation
and the choices that need to be made. With clear professional guidance,
and with appropriate strategic commissioning, GPs should be able to
deliver the improved outcomes this article desires - the future of child
health lies in their hands.
david.jones3@nhs.net
Competing interests: No competing interests