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Re: Continuing professional development in child health surveillance

This paper[1] on the role of a coordinator in child health surveillance/promotion (CHS) is both opportune and timely given the degree of interest generated in preventive healthcare for a variety of reasons. Blair has brilliantly summarised the activities covered by the programme that needs coordinating. One aspect which needs to be highlighted further is the area of training.

The author has quite rightly pointed out that with the 1990 NHS Act, the provision of the preschool programme is generally delivered by primary health care teams including general practitioners (GPs) and health visitors. Most districts have a clear process of GP accreditation to deliver CHS in practice based on the national guidance[2] in place since 1990. This paper does not offer clear guidance on the need for reaccreditation and continuing professional development (CPD). In 1997, there were some discussions at the college level to draft updated guidance on the processes for accrediation and CPD. Unfortunately the discussions never concluded. In view of clinical governance it may be timely to reconvene these discussions as training and update programmes for the primary health care teams are critical to the success of CHS. In the absence of national guidance individual health authorities tend to produce (or not produce) their own local guidelines which tend to be of variable effectiveness (personal experience).

References
(1) Blair M, The need for and the role of a coordinator in child health surveillance/promotion. Arch Dis Child 2001;84:1-5.

Send letter to journal:
Re: Re: Continuing professional development in child health surveillance

Dr Nathwani has highlighted an important area in relation to training and child health surveillance. Once we are clear about what we need to do, the next step is to (further) develop a competent workforce to provide the service as prescribed. To date, most Districts have interpreted RCGP (Royal College of General Practitioners) and BPA (British Paediatric Association; pre Royal College) guidance locally in order to assure themselves of competence. What he is really asking is whether this is effective?

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Re: Audit of standards in Child Health Surveillance

We read with interest the article on the need for and the role of a co- ordinator in the provision of child health surveillance (CHS)[1] and particularly the need to work with the Primary Care Team in developing quality standards.

We have used such standards in City and Hackney for the past 5 years. When a General Practitioner (GP) applies to join the CHS list the Consultant Community Paediatrician for that practice visits and discusses these standards, advising the GP to attend a CHS course and local clinics. We audited these standards by asking GP’s attending the weekly post - graduate teaching to complete a questionnaire.

19 (56%) of the 34 GP’s attending that session completed the questionnaire. Of these, 68% were registered for CHS, 90% had attended a CHS course but only 47% locally.

The number of under-five’s registered with these practices ranged from 120 to 1000. 63% held dedicated child health clinics but only 53% had clerical support to deal with the Personal Child Held Record.

68% had suitable scales, 79% a height measure (mostly described as permanent and attached to a wall). Age appropriate toys were available in 63% of surgeries. 90% had a dedicated vaccine fridge but the community pharmacist had visited only 5% to give advice.

79% of the responders had the local CHS Manual; only 63% had the Area Child Protection Committee Guidelines. 68% had received child protection training but only 13% within the last 5 years.

It would be difficult to generalise to all the GP’s from this self- selected group who may have been interested in the CHS lecture that day or keen to receive PGEA hours. Currently 55% of GP’s are on the CHS list in this area and our sample exceeded this with 68% being accredited. However it is clear that even amongst a group where high numbers are accredited the standards that most paediatricians would consider to be essential, for example, an adequate pair of scales or recent child protection training, are not always met.

The Primary Care Trust has a responsibility to ensure adequate standards in primary care and we have a responsibility to support high quality CHS. We hope that this study will help to improve standards if it is extended to include all GP’s and the findings acted upon with managerial support.

Yours sincerely,

Emma Devereux and Deborah Hodes.