Tomorrow morning I’m attending an event that’s been organized by a mobile network operator to look at the issues relating to online protection of children. I think this is a great initiative from O2/Telefonica and thought it might be helpful to share my thoughts on how I think mobile can be leveraged to make GPs more effective.
Let’s first get an appreciation of the scale of the informational problem that exists here. In the last 5 years there have been at least 5 documents produced that have been squarely aimed at GPs:
> Working together to safegaurd Children, National interagency guidance (2006)
> 0-18 years guidance for doctors on child protection, General Medical Council (2007)
> RCGP/NSPCC toolkit for GPs (2008)
> Child Protection – a toolkit for Doctors, BMA (2009)
> When to Suspect Child Maltreatment, NICE (2010)
As part of my research I’ve being reading through them all and I’m just amazed at how every one seems to follow yet another horrific high profile death of a child that had been identified as at risk. As I read these reports, Dr Paul Knapman, a Westminister coroner is conducting an inquest into the death of an 11-month-old baby boy whose emaciated body was found in his cot surrounded by rotting food. It’s very clear that whilst the child was being monitored by Doctors and social services he’d been left with his four-year-old sister in the care of a mentally frail, HIV-infected mother. So why isn’t this educational effort working? And why am I left thinking change isn’t happening and we’re probably due another written report sometime soon?
Firstly it’s not about a lack of resources – indeed the investigation of this latest case has so far consumed £1 million. I think it’s because it’s forever just a reactionary effort trying to quell the latest storm and appease the public that something is being done as though it’s a case of “here’s another report, our job is done”. But when you look at what is supposed to have been done in terms of education of frontline workers no one can begin to quantify it. Yes I’m sure that the reports were marketed and read but what was the effect? Are Doctors better educated, more sensitive, more confident about getting involved with social services?
Instead of more straight line thinking and reports why aren’t there collaborative tools being created for something as important as child protection? Why are we relying so much on busy GP’s to detect and report child abuse instead of collaborating to create tools that can aid them? Where are the resources to enable GPs to participate in case conferences? In 2011 is a 50+ page tool kit really the best way of reaching GPs? Where are the interactive video training tools that are being deployed in almost every other profession?
Record keeping and document management
Very often I see GPs switching off when they hear another sales pitch from a technology vendor. It doesn’t surprise me because I’ve yet to meet one that hasn’t got a IT vendor horror story to tell and they probably shouldn’t even be in a position where they have to weigh up such technologies. In my opinion it’s about time that outdated solutions involving paper and pens were simply taken away from them and replaced with modern working solutions.
In my opinion the last argument for keeping patient based records was lost when that council staff member left a 15 page confidential child protection report on a train but there are also cost effective working solutions that have already proven themselves in similar environments eg. the digital pen solution deployed by midwives at Portsmouth NHS Trust. This not only ensures patients get a written copy every time they meet with a health professional but it also means a digital record is automatically filed helping document things so that they can be managed properly. Resources aren’t an issue either as this initial deployment for example brought a return on investment within a few weeks as a result of increased productivity and time savings alone.
Another example of a working solution would be interactive patient history taking software that could interview patients in their own language via touch screens located in the waiting room. Not only do these help patients communicate with their carers but they save clinicians time because they can simultaneously document and convert this history into the Doctor’s language. One of the big findings in this latest situation is that there was again a language barrier as the mother didn’t speak English. With the usual straight line thinking the next report will no doubt prescribe that all GP’s are sent on language training courses, but if we think about how we can redesign the solution it can give a much better outcome.
Not only are abusive parents more likley to be honest when choosing answers to a questionnaire than when replying face to face with a GP but the use of a computerised system would enable more skills (gleamed from the knowledge bases contained within these training reports) and questions (the computer doesn’t get tired, feel the need to rush things etc) to be brought into frontline detection processes.
Sue Learner a freelance journalist has written a brilliant article in the BMJ (2011;342:d1015) that sums up some of the key issues with the ineffective communciation processes that GP’s face as they try to interact on child protection issues with members of social service teams:
“If I am worried about a patient on medical grounds I will speak to a senior Doctor. But if I have a child protection worry, I will ring up social services and more often than not I get put onto a junior social worker. Too often, they either don’t react at all or they over-react. GPs need to be able to speak to senior social workers who have a lot of experience” Dr Iona Heath, President of the RCGP
To the technically minded the solution to this is rather obviously a secure messaging system that can support asynchronous communication.
Obviously there still will be times when the GP needs to be present eg. case conferences but look at how badly they’re doing this:
“My colleague looked at 63 consecutive child protection case conferences and found GPs had not attended any of these conferences. Only 5 out of 63 GPs sent a report” Dr John Dracassm, Safegaurding Children, Hampshire PCT
“The last 3 case conferences I have been asked to attend have been at 10 am on a Monday morning. How can I go when I have a surgery full of patients?” Dr Charles Wilkinson, Wiltshire GP
“Attending a case conference would often mean cancelling a surgery” Kambiz Boomla, Tower Hamlets GP
“There guidance (for GPs to attend child protection cases) was never feasible in the first place… there is a real endemic problem with case conferences being held at short notice and during surgery hours” Dr Iona Heath, President, RCGP.
I’m very surprised there’s no attempts to introduce secure video conferencing for these sessions as the ability to bring in a Doctor when she’s needed seems like a logical solution to this.
I look forward to learning more… why not join me?