Child Health Surveillance Lists.
Published 1991 · Medicine
Many reasons exist why health services for children are best provided by the primary health care team. General practitioners and health visitors have a long tradition of caring for families and visiting them in their homes. The consultation in general practice is the ideal opportunity to offer preventive and therapeutic care. And general practice is based on local communities, accessible to 95% of the population, and cost effective. Recognition of this dates back to the Court report (1976), which advocated that child surveillance should increasingly take place in general practice (rather than in the community services).' Progress towards the two tier delivery recommended by Professor Court has, however, been slow. Milestones along the way include Healthier ChildrenThinking Prevention,2 which advocated that child surveillance should be part of the core of general practice, and the Handbook of Preventive Care for Pre-school Children.' Later came Health for All Children, containing the views of a working party chaired by Dr David Hall, which looked critically at all aspects of child surveillance and recommended a core programme.4 A second edition refining earlier recommendations and defining responsibility will be published soon. Since 1 April 1990 the new contract has remunerated general practitioners for carrying out child surveillance provided that they have been accepted for this by their family health services authorities and their names appeared on the approved lists.5 The Royal College of General Practitioners and the British Paediatric Association issued joint guidelines in December 1989, which were intended to help family practitioner committees (since renamed family health services authorities) in selecting general practitioners for admission to their approved lists.6 These guidelines are currently being updated in consultation with the General Medical Services Committee and Joint Committee for Postgraduate Training in General Practice. Yet Evans and colleagues report considerable variation in the criteria adopted by the managers of family health services authorities for admitting general practitioners to approved lists. Many general practitioners understandably resent the discrepancies that have led to approval by one family health services authority but not its neighbour (p 229).7 Standard setting should be a professional exercise. The widely varying standards highlighted by Evans et al are a telling reminder that leaving this to managers is likely to produce as many criteria for accreditation as there are family health services authorities. Children are an investment in our future; allowing them to achieve their potential is the main purpose of child surveillance. This is too important to be left to local prejudice-parents and children deserve a uniform standard of care wherever they live. With its recommended core programme of child surveillance Health for All Children was an important step forward. But a core programme is not enough: national standards should exist, from which all children should benefit. Standards are a professional not a managerial responsibility. Of course our ultimate aim should be to ensure that all future entrants into general practice are appropriately trained so that an accredited list is unnecessary. This issue is currently being addressed by the Royal College of General Practitioners and General Medical Services Committee working within the Joint Committee for Postgraduate Training in General Practice.