Thursday, 21 January 2016

Why schools should not say "Get A Note From Your Doctor"

According to the Mail on Sunday, a growing number of schools are now demanding that parents of children unfit to participate in PE lessons consult GPs for letters.


"Bundesarchiv B 145 Bild-F010151-0007, Salzgitter-Lebenstedt, Volksschule" by Bundesarchiv, B 145 Bild-F010151-0007 / Steiner, Egon / CC-BY-SA 3.0. Licensed under CC BY-SA 3.0 de via Wikimedia Commons.


GPs are contracted to treat those who.are unwell or believe themselves to be unwell. In reality, most people know well that most illnesses are self-limiting and do not require medical treatment. If everyone consulted a GP about every self-limiting illness, we would be swamped. (Clearly, establishing that an illness is self-limiting can only be done confidently with hindsight; until then, judgement and risk-taking is required, whether that be of the patient or parent or of a healthcare professional).

With the growing workload in general practice and finite resources, it is imperative that we move towards less professional healthcare involvement (and/ore acceptance of risk by patients/parents/teachers/employers) in the treatment of self-limiting illnesses.

Writing notes for school is not an activity that GPs are contractually obliged to undertake. As such, they would be entitled to charge parents for such work if no other body is willing to fund it. This has the potential to discriminate against those least able to pay, also likely to be those most likely to be unwell. The blame for such discrimination would consequently lie squarely with those setting this policy, not with GPs.

Of course, it is not all about money. A very real danger here is that this policy will encourage more parents to bring their children to see their GP for self-limiting illnesses or perhaps even non-medical problems. The cost of this will be that the unwell will have to compete with this new group of patients for access to healthcare.

I also question whether I as a GP would be best-placed to make an assessment of whether a child is fit to exercise. If a parent says they are not, I would be inclined to believe them. If this happens frequently and they do not have a chronic medical condition (and would therefore be likely to provide evidence such as repeat prescriptions, obvious disability or hospital appointment letters), I might gently challenge that view. There is no reason why a teacher or school nurse could not do the same.

If a school nurse had concerns about a child's health (or perhaps that they might be missing too much PE), I would be very happy to speak to them as one healthcare professional to another.

If trust between parents and teachers has been lost, it is not the responsibility of GPs.

If anyone thinks general practice might be able to help with a particular problem, they should reach agreement with GPC before issuing advice to a population. This was one of the recommendations (3.3) contained within the Further Blueprint for Primary Care I co-wrote with Dr Hussein Gandhi (+Dr Gandalf ) in June 2015.

This is the full version of a response of mine quoted in an article in +Pulse Today.

1 comment:

mark sehgal said...

I am with the school because sometimes the child gets injured and the parents just have to blame the dissertation service without knowing the medical fitness for the game but now the school is taking a precautionary step and that is good for both of them.