Woodman, JL; (2014) General Practitioner responses to concerns about (possible) child maltreatment in England: a mixed methods study. Doctoral thesis , UCL (University College London).

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Abstract

Background: There is increasing recognition that GPs’ responses to maltreatment-related concerns should include but go beyond referral to and joint-working with children’s social care. However, the role of the GP in this area remains contentious and wider responses in general practice are not fully defined. Aim: To describe and understand responses to concerns about child maltreatment in general practice in England. Methods: I estimated the annual incidence of maltreatment-related codes in children’s electronic primary care records (over time, by child characteristics) and estimated between-practice variation using a UK representative cohort of 1.5 million children from The Health Improvement Network (THIN) database. I also calculated prevalence estimates for 2010. I investigated other responses to maltreatment-related concerns through unstructured in-depth interviews with GPs (N=14), health visitors (N=2) and practice nurses (N=2) and observations of team meetings (N=4) in four practices in England. I undertook a development phase with 11 GP practices in England to prepare for the study proper and used literature reviews to drive my study design and contextualise my results. I aimed to increase the breadth and depth of my findings by adopting a mixed methods design (integrating quantitative and qualitative data). Results: In 2010, the annual incidence of children with any maltreatment-related code was 9.5 (95%CI 9.3, 9.8) per 1000 child years, equivalent to a code entered in the record of 0.8% (95%CI 0.8, 0.8) of all children registered in 2010. I identified seven actions that GPs described taking in response to maltreatment-related concerns. GPs enacted responses through parents and other family members as well as children. From the GPs’ perspective, strong relationships with parents and health visitors were prerequisites for responding to maltreatment-related concerns. Conclusions: My findings challenge policy makers, professionals and researchers to rethink the GPs’ role in responding to maltreatment-related concerns

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