Intended for healthcare professionals


GPs need to be more proactive in providing health care to teenagers

BMJ 1996; 313 doi: (Published 12 October 1996) Cite this as: BMJ 1996;313:941
  1. Nicola Cowap, General practitioner
  1. 12 Parolles Road, London N19 3RD

    EDITOR,—When asked what type of contraceptive services they want, teenagers say that they want services that are local and that are accessible every day and in an emergency. This type of service is more readily provided by general practice. In addition, general practitioners and their colleagues have the opportunity to discuss health issues in general with teenagers. There is evidence, however, that teenagers receive suboptimal care in general practice and that general practitioners frequently fail to make the most of the opportunities afforded by routine consultations.1 As Anna Graham and colleagues have found, those teenagers most in need of help and information may be those least likely to receive them.2

    Colleagues and I tried to address the problem of teenage health care in a deprived inner city population by running weekly teenage clinics in two general practices in east London over six months. This model has been tried with some success elsewhere, although published reports largely refer to middle class, affluent populations.3 4 5 Despite approaching all 13–17 year olds in the practices directly, we achieved only a 7% (63/867) attendance among all those invited. We had greater success when we targeted 15 and 16 year olds and invited them to the clinic for booster doses of tetanus and polio vaccine, achieving an attendance of 12% (43/349), as opposed to 2% (6/262) among those receiving general invitations. Colleagues attempting to run teenage clinics in similarly deprived areas have experienced similarly low attendance (personal communications).

    Teenage clinics may therefore not be the answer to improving access to contraception and health care for high risk teenagers. General practitioners may need to be more proactive in routine consultations, allow flexibility in appointment systems, and, above all, ensure confidentiality. We may also need to acknowledge the public health dimension of unplanned pregnancy and be prepared to work in schools and other non-traditional settings, liaising more closely with other agencies both within and outside the health sector.

    The most important consequences of unplanned pregnancy among teenagers are socioeconomic rather than medical, and the problem should be addressed at this level. Nevertheless, health professionals, particularly general practitioners, have an important role in health education and the provision of services. With the increasing concern about teenage health, we need to take up the challenge.


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