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The call for knife crime to be tackled as a “public health issue” is welcome – but in opposing part of the motion Dr Gillian Beck raises an important point. It would be a mistake if this approach were to place too much emphasis on interventions by GPs aimed at primary prevention. However, this is not only because GPs are already overburdened with other responsibilities, but perhaps more importantly, because the individuals most at risk of involvement in knife crime (either as victims or perpetrators) are the segment of the population least likely to have any interactions with a GP.
In the UK, the majority of penetrating trauma cases involve young males (Whittaker et al., 2017). For example, Olding et al. (2019) reported that, at a London trauma centre, from August 2016 to July 2017 the majority of patients with penetrating trauma due to interpersonal violence involved were male (88%), and individuals under 30 (69%). However, in primary care, the lowest clinician consultation rates are seen for males in the 10-14, 15-19 and 20-24 year age bands (Hippisley-Cox & Vinogradova, 2009).
For victims of knife crime (including perpetrators who are injured), treatment by ambulance service and emergency department staff will often constitute the first interaction with a clinician they have had for many years. Consequently, interactions with clinicians are most plausible as a route for interventions aimed at secondary, rather than primary, prevention – i.e. reducing the likelihood of future involvement in knife crime for individuals who have already sustained an injury.
REFERENCES
Hippisley-Cox, J. & Vinogradova, Y. (2009). Trends in Consultation Rates in General Practice 1995 to 2008: Analysis of the QResearch® database. Final Report to the NHS Information Centre and Department of Health. Available from: https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01077/tren-co...
Olding, J., Olding, C., Bew, D., & Fan, K. (2019). Penetrating head & neck trauma – epidemiology and injury characteristics in terror-related violence, interpersonal violence and deliberate self-harm at a level 1 trauma centre. Surgeon, 17(3), 133-138. http://dx.doi.org/10.1016/j.surge.2019.01.001
Whittaker, G., Norton, J., Densley, J., & Bew, D. (2017). Epidemiology of penetrating injuries in the United Kingdom: A systematic review. International Journal of Surgery, 41, 65-69. http://dx.doi.org/10.1016/j.ijsu.2017.03.051
Competing interests:
No competing interests
13 September 2019
Nicholas Pound
Senior Lecturer in Psychology
Department of Life Sciences, Brunel University London, Uxbridge, Middlesex UB8 3PH, United Kingdom
Re: BMA calls for knife crime to be tackled as a public health concern
The call for knife crime to be tackled as a “public health issue” is welcome – but in opposing part of the motion Dr Gillian Beck raises an important point. It would be a mistake if this approach were to place too much emphasis on interventions by GPs aimed at primary prevention. However, this is not only because GPs are already overburdened with other responsibilities, but perhaps more importantly, because the individuals most at risk of involvement in knife crime (either as victims or perpetrators) are the segment of the population least likely to have any interactions with a GP.
In the UK, the majority of penetrating trauma cases involve young males (Whittaker et al., 2017). For example, Olding et al. (2019) reported that, at a London trauma centre, from August 2016 to July 2017 the majority of patients with penetrating trauma due to interpersonal violence involved were male (88%), and individuals under 30 (69%). However, in primary care, the lowest clinician consultation rates are seen for males in the 10-14, 15-19 and 20-24 year age bands (Hippisley-Cox & Vinogradova, 2009).
For victims of knife crime (including perpetrators who are injured), treatment by ambulance service and emergency department staff will often constitute the first interaction with a clinician they have had for many years. Consequently, interactions with clinicians are most plausible as a route for interventions aimed at secondary, rather than primary, prevention – i.e. reducing the likelihood of future involvement in knife crime for individuals who have already sustained an injury.
REFERENCES
Hippisley-Cox, J. & Vinogradova, Y. (2009). Trends in Consultation Rates in General Practice 1995 to 2008: Analysis of the QResearch® database. Final Report to the NHS Information Centre and Department of Health. Available from: https://files.digital.nhs.uk/publicationimport/pub01xxx/pub01077/tren-co...
Olding, J., Olding, C., Bew, D., & Fan, K. (2019). Penetrating head & neck trauma – epidemiology and injury characteristics in terror-related violence, interpersonal violence and deliberate self-harm at a level 1 trauma centre. Surgeon, 17(3), 133-138. http://dx.doi.org/10.1016/j.surge.2019.01.001
Whittaker, G., Norton, J., Densley, J., & Bew, D. (2017). Epidemiology of penetrating injuries in the United Kingdom: A systematic review. International Journal of Surgery, 41, 65-69. http://dx.doi.org/10.1016/j.ijsu.2017.03.051
Competing interests: No competing interests