GPV is a QIC accredited organisation

General Practice

Role and experience as key providers of comprehensive health assessment for children and young people entering out-of-home care

Sonya Tremellen & Dr Hubert Van Doorn

Why is primary care best placed?

• GPs most readily accessible medically qualified professionals

• GPs first point of entry in Australian health system & can identify needs & refer appropriately

• GPs have medical skills to identify & manage breadth of health care needs across ages and stages

• Attending GP clinic is normal, non-stigmatising experience

Are GPs ready and willing? – Research Findings

• GPs not ready to undertake child health assessments without some changes in practice systems

• GPs positive about potential benefits, but have ethical concerns• Epidemiology of child abuse and neglect not widely shared with

general practice• GPs would welcome further training and professional

development support• Links between the GP and child protection sector need

improvement• GPs are wary of red-tape burden & medico-legal complications• Workforce and financial pressures have critical influence• GPs prefer health assessment to be a first step in an ongoing

therapeutic relationshipWebster SM, Temple-Smith M. (in press) Children and young people in out-of-home care: are GPs ready

and willing to provide comprehensive health assessments for this vulnerable group? Australian Journal of Primary Health

GP Engagement: Field testing

9 GP Advisors from across Victoria confirmed that:

• professional development module appropriate

• Commissioning letter from DHS required (along with medical history)

• Medical software template essential• GP provides Summary Report &

Recommendations• $300 fee-for-service• Require clarity re: consent for

treatment• Concern re: follow-up & continuity

Workshops held September 2008 & March 2009

The pilot – process findings

General Practice successfully recruited2 month turn-around is achievableMedical histories arrivedChildren & young people knew what they were there forGP assessment time: 45 + minutes (average)Practice Nurse assessment time: 30 minutes (average)GP Report time: 30 minutes + (average)GPs satisfied with remuneration

The number of referrals to GPs made by Child Protection much lower than expected (27 over 14 months)

Of the 13 GPs trained, 6 received a referral

Health assessments n=246 (25%) children under-immunised3 (12%) required treatment for acute illnessImportant health issues identified20 (83%) required referral (15 different service types)• Paediatrician • Dentist• Renal Unit at Royal Children’s Hospital• Orthopaedic and Plastics Unit at Royal Children’s Hospital • Back X ray• Wellbeing Coordinator at school • Hepatitis C Screening test• Optometry • Audiology • Psychologist • Family Planning/sexual health• Podiatry • Educational support required for literacy and numeracy• Hepatitis B immunisation• Speech therapist

Who does what? PN and GP roles

Nurses:• set up appointments & entered medical history into

General Practice medical record• Checked immunisation, height, weight & some did more

GPs:• Established rapport• Comprehensive physical & behavioural examination

Practices work it out

Team work

Focus Group discussion

• Recognised complexity of client group and time required for thorough assessment

• Highly valued the opportunity to participate given evident benefits to children & young people

• Demonstrated the role of the practice nurse and value of teamwork in the practice

• Identified effective ways to manage the consultation• Organisational issues• Concerns re: Follow-up

Addressing enduring concerns

• Initiate and sustain GP engagement – work through GP organisations

• Strengthen the link between health and child protection sectors

• Support clinical governance and continuity of care

GPV is a QIC accredited organisation

Questions

Final report available from: www.gpv.org.au

Contacts: Sonya Tremellen

s.tremellen@gpv.org.au

03 9341 5205