GPs told to 'coach' parents on healthy behaviour to prevent child abuse

GPs should 'coach' parents on healthy behaviour, including how to drink alcohol responsibly, to better protect children against maltreatment, according to an expert review of GPs' role in safeguarding.

GPs should monitor and coach parents in vulnerable families, the report says (Photo: Jason Heath Lancy)
GPs should monitor and coach parents in vulnerable families, the report says (Photo: Jason Heath Lancy)

The review found cases of child maltreatment are being missed by NHS and social services but that GPs were well placed to take on a greater role in identifying those at risk and taking direct steps to prevent abuse.

However, experts warned that GPs may not have enough time to fully engage with families' problems without reorgnisation of care and investment in general practice.

The call goes beyond GPs' current safeguarding duties and urges GPs to be proactively involved in offering long-term support and monitoring of children and family members.

The report, The GP’s role in responding to child maltreatment, was published by the RCGP, the National Society for the Prevention of Cruelty to Children (NSPCC) and researchers from University College London (UCL) and the University of Surrey.

Just one in nine children experiencing maltreatment receives a protection plan from social services, the NSPCC says.

Greater role for GPs

The report argues that GPs, as the first point of contact for many families, could work more closely with social care to highlight issues such as child neglect and emotional abuse.

GPs should use 'monitoring, coaching and advocating' skills to help parents with issues that affect their children, such as alcohol use or mental health problems.

Coaching involves 'motivational interviewing', in which GPs encourage parents to take responsibility for their health and change their behaviour.

Yet authors admitted there was a lack of evidence around the safety and efficacy of direct responses to maltreatment-related concerns by GPs.

GPs taking part in previous studies into coaching and advocacy interventions had also warned the strategy could backfire.

Warning over patient-doctor relationship

They were concerned that if the doctor-patient relationship was not sufficiently strong, 'attempting to "coach" patients might scare them away from using services and a dysfunctional doctor-patient relationship might promote tolerance of "bad" behaviour by doctors or may make GPs more likely to miss new and serious symptoms'.

Report authors concluded such an approach was likely to be feasible in general practice, but challenges exist around costs and the integration with other services.

Dr Maureen Baker, RCGP chairwoman, said: 'GPs do the best they can to ensure that children are kept safe and well. By recognising early signs of strain in children and their families, which may involve physical or emotional symptoms, GPs can be of real help and in some cases help prevent situations or conditions getting worse.'

It was 'unacceptable' that only half of trainee GPs undertake a specialist paediatric placement, she said, adding that the RCGP was campaigning to extend GP training to four years to increase emphasis on child health and mental health.

Jenny Woodman of the UCL Institute of Child Health, lead author of the report, said the findings were 'positive' and showed GPs can help vulnerable families.

'Policy and guidelines focus on the GP’s role in referring children to social care services, but this is only a small part of what GPs can do. Policy makers should look at what is already happening in some GP practices and think about the policy and other services that can support GPs to use their skills as family doctors to help maltreated children and their parents.'

Investment needed to free up GP time

Chris Cuthbert, NSPCC head of strategy and development, said: 'By spotting opportunities to help families face to face, and to intervene before problems become chronic, GPs could ultimately reduce the number of children needing to enter the child protection system.'

Surrey GP Professor Simon de Lusignan of the University of Surrey said front-line pressures prevented GPs having the time to explore complex social and family issues impacting a child's health and wellbeing.

He said: 'Reorganising care so that there is more time given to those who need it - in this context, children who are at risk or who are maltreated - can only improve general care and help keep families together and children safe from harm.'

Key messages for GPs

GPs should:

  • Recognise that they can contribute to a public health approach to child maltreatment through directly responding to families as well as participating in the statutory child protection system.

  • Use core skills of general practice to facilitate and enact direct responses to families with maltreatment-related concerns, including:

    • developing and maintaining a strong doctor-parent and doctor-child relationship.

    • monitoring, coaching and advocating for families and providing opportune healthcare to children and parents.

  • Work sensitively to support parents caring for children and to encourage engagement with primary care and at the same time take action to keep children safe.

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