Suspected Child Abuse and Neglect - GP Referrals
Dr Ralph Wiles Chairperson Royal NZ College of General Practitioners
Launch of “Recommended Referral Process for General Practitioners: Suspected Child Abuse and Neglect”
Beehive Foyer, Parliament Buildings, Wellington
3.30 pm 3 May 2001
EMBARGOED UNTIL DELIVERY
The Royal NZ College of General Practitioners is proud of its contribution to tackling an issue which ranks amongst the most important faced not only by primary care but by society as a whole, and we congratulate the Ministers, their respective Ministries and everyone involved in the preparation of this document and in its implementation stages.
An important role of General Practice is to discern those patients who need further evaluation and possibly treatment. Potential child abuse is complex and the ramifications of wrongly reporting it can be just as profound as those of failing to detect it. If there are grounds to suspect it’s occurring, the common role of the GP is to refer to a specialist, usually a paediatrician, who will undertake special investigation and notify if appropriate. The measure of the success of this document, therefore, will not be an increase in the number of GP notifications, but rather in the number of GP referrals.
It is GP referrals which, in cases where abuse is verified at specialist level, lead to a significant proportion of the eventual notifications. This is the GP’s role – not so much direct notification, but referral to those people who eventually do notify. For abused children to be given a more effective service, not only must the implementation of this document be adequately funded, but additional resources must be provided to all professionals who notify abuse, and to those whose job it is to protect the child.
Before the drafting of these referral processes there was not, despite what some sections of the media might portray, a dearth of information and support for a GP in that position. The College has several guidelines which assist GPs with issues affecting young people, including abuse. They include:
· Health for Young People, which deals with the communication skills needed to talk to young people about sensitive issues, mental and sexual health, and a variety of other issues.
· Wellchild (A General Practice Response to the Wellchild Strategy), which features a section specifically on child abuse and another on “Dealing with children and families at risk”. That was launched last year.
· And the Detection and Management of Youth Suicide Guidelines I referred to earlier – less relevant to the immediate problem but sadly, often a part of dealing with the aftermath of abuse.
These are not just worthy tomes which gather dust on doctors’ bookshelves. They are part of a set of quality improvement tools which GPs must use if they are to complete the College’s requirements for Continuing Medical Education, or CME, which in turn is required by the Medical Council for ongoing professional registration.
And that imperative goes beyond using these tools to monitor and improve practice responses to these sorts of issues – GPs must also attend CME meetings. These might be discussions, lectures, workshops or some mixture of these. And amongst the CME offered is training by Doctors for Sexual Abuse Care, which covers dealing with suspected and verified sexual abuse of children in a General Practice setting.
So we, as a profession, have not been idle. The referral process released today builds upon and consolidates work that has already been taking placed in General Practice – some of it for quite some time.
It also goes beyond what we have had to work with before, and offers doctors an invaluable, focused, single point of reference when confronted with suspected abuse or neglect.
Having played our part in writing the document – and for their work we thank Drs Jim Vause, Caroline Corkhill and Jan Whyte, along with Maureen Gillon and Cathy Webber – we now look forward to working with the Ministry of Health and Child, Youth and Family on the implementation.
The creation of this document, and the training and professional development which will flow from it, is an example of what can be achieved when organisations and people involved in primary care come together with a determination to tackle a problem. However, we should not, in congratulating ourselves on a job well done, delude ourselves that we have provided anything more than part of the answer to child abuse. And still there remains the broader question – that of how to deal with family violence.
General practitioners, in common with the rest of the community, have a very real desire to do all that they can to combat the problem not only of child abuse but also the broader issue of family violence. But we cannot afford to become complacent and assume that abuse will always be detected and dealt with by front line professionals – be they doctors, nurses, teachers or police. It remains a community problem and we all, as individual members of the community, have a role to play in preventing it.