A new term

A summer image-at Freya Cabin on Keilder Water, Northumberland

Memories of summer are behind us and autumn has arrived to mark the first meeting under my watch of the Adolescent Health Group . We were a full house with almost standing room only! The meeting was held at RCGP Bow Churchyard and we are appreciative of the support from CIRC and of our administrative officer, Hannah Price. We look forward to developing our relationship with the team at CIRC, including Chris Gush (Head of CIRC) and  Imran Rafi (Clinical Director).

It was a real pleasure to welcome new members and to see established and longstanding members steadfast and consistent in their support to make general practice more adolescent friendly.

Key points to reflect upon:

1.     1.  Our thriving relationship with AYPH (www.youngpeopleshealth.org.uk). Under the dynamic leadership of their Development Manager, Emma Rigby, our portfolio  of joint projects continues apace.

• ·         Watch this space for our national tour when we jointly deliver BMJ Master classes in Adolescent Health at a venue near you! We are delighted that the call has come from the BMJ Master Class Series Editor, Dr Christine Ward, in response to a demand from GPs and see this as an indication of a growing awareness of young people’s particular needs.

• ·         We are organizing a joint conference in the appealing city of Cardiff in wonderful Wales, March 27^th 2012: Putting Research into practice. The call for abstracts and further details will be announced shortly

• ·         November 23^rd sees the general release of the latest Key Data in Adolescence (Ed s: Coleman J, Brooks F, Threadgold P.) The data will soon be available to members of the AYPH via the website.

2.        2.We have  been invited to respond to the government’s latest document for  consultation : ‘Positive Youth’.

3.       3.The group is working on a series of proposals to honour the memory of Dr Anne McPherson who was a founding member and seminal influence of the Adolescent Health Group .

4.     4.  Supporting Education across the life course of a primary health care practitioner’s professional life remains core to our role and we are looking at how we draw together our collective experience and expertise and work with key stake holders to roll out initiatives of good practice.

Finally, the group was featured in October’s RCGP News-p 2.

Next week the group leads on a symposium ,to be  held at RCPCH, defining the key role of general practice in adolescent mental health.

Please keep tuned into the blog for more news of forthcoming events and feedback on the projects mentioned above.

With good wishes

Jane

jane.roberts@sunderland.ac.uk

The sad summer of 2011

 17^th August

And so today, as it was predicted, very sadly a 14 year old young man, was found stabbed to death in a park in Enfield, London.

The riots of last weeks, shocking and disturbing though they were, were also not so surprising when given the social conditions of the areas where the  unrest took place.

This blog will not add to the myriad of explanations that have been offered suffice to say that whilst England continues to be one of the most unequal countries, and London the most unequal city, in the western world we should not be surprised. The richest 10 % in London earn 273x more than those at the bottom.  And for those looking for work the statistics are equally disturbing. In Hackney ONS statistics  show less than 500 vacancies for 11,000 claimants. Youth unemployment is at a record 20%. As health practitioners we should be concerned about the implications for this. We have all seen the effects of chronic worklessness and its toll on mental and physical health in adult populations. Young people will be similarly, perhaps more markedly harmed, by the lack of opportunity.

For many of us this does equate to a ‘sick society’ which needs reparation and compassion.

In the wake of the riots we now  see a hard-line rhetoric which only threatens to aggravate marginalized groups of largely young people who see themselves as having no stake in this injust society.

 Lord Ken Macdonald, a former DPP and QC, defence  barrister, has questioned the logic of evicting  families from their homes because one of the children has been involved in looting (21 % of all those convicted are aged between 11-17 yrs).  He debates the rationale behind the issuing of tough sentences which are ‘contrary to the norms of justice’ and  ’ lack humanity’.

And how do we humanely support children growing up in father-less households? As one teenager interviewed asked; ‘Will there be a shop selling fathers?’ Who will replace  the father’s of children we meet in surgery presenting with behavioural problems -whose fathers have died of alcoholism, or accidents, or as a result of war in conflict zones  in unstable parts of the world ?  

We need to take stock from other countries which have weathered these storms and emerged with compassion and dignity, the most recent example being  Norway where their leadership has  promoted restraint and prosocial behaviour. It is true, we have our inspirational examples nearer to home, like the grieving family of Haroon Jahan in the Midlands. Our political leaders would be wise to follow such examples.

Jane Roberts

Cuts to services as a major threat to young people's health

The cuts to youth services made in the name of ‘savings’ are giving great cause for concern for the health and well-being of many young people in the UK this summer . More than £100million was removed from Local Authority Services for young people up to March this year, according to the confederation of Heads of Young People’s Services. “Almost 3, 000 full-time staff who work with young people have lost their jobs.”

In my own practice area the posts of Parent Support Advisors, based in schools, who worked with parents to maximise their children’s engagement with  learning have been axed. The  PSA’s were often a very effective link between home and professional services  for vulnerable families, including accompanying teenagers to see their GP or to attend CAMHS appointments. Who will step in to take up their role once their contracts are not renewed ? 

MPs on the Education select committee have expressed their disapproval of the trenchant cuts. The committee’s chair,  Graham Stuart has said the” disproportionate budget reductions” could have “ dramatic and long-lasting” consequences and an increase in crime was “inevitable”.   

See www.guardian.co.uk (30/07/11)

The worst case scenario for a disaffected generation of young people this summer, bored and broke, is a descent  into social fragmentation and a rise in crime-with their peers the obvious targets. According to Scotland Yard victims in the age group 13-24 years have increased by 30% between 2008-09 and 2010-11. For all of us working with this population, this is a very concerning trend which has serious and widespread ramifications for the communities in which knife crime is a real reality. As health professionals we need to be mobilizing against this  social phenomenon which has relative poverty and social inequality at its centre.

Jane Roberts

jane.roberts@sunderland.ac.uk

31/07/11

July update

[Photo taken at SAPC annual scientific meeting at Bristol, July 2011, at the welcome wine tasting, catching up with Prof Kelsey Hegarty from Melbourne who presented some fabulous work on domestic violence]

Hope everyone reading this is well and looking forward to  having a break over summer.

I wanted to update you on  a few adolescent health matters.

There has been a release of the recently modified You’re Welcome criteria

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_126813

Well worth reading and accessing the check list but regrettable that the ring-fenced money for supporting practices has since been withdrawn and the check list activity will carry no quality assurance (and rely on rater honesty!). Also, regrettable that no primary care staff seem to have been involved in the working party who update the quality criteria (see acknowledgments).

It seems we have more work to do to raise the profile of GPs’ clinical involvement in Transitional care when young people move from paediatric  to adult services. This has been a key area of DH activity and was also the subject of a workshop we ran at RCGP Conference 2009 but we need to let more people know what happens in day to day practice and contribute to training and development. Like starting senior school, moving out of paediatric and child centred care into adult services can be tricky and unsettling with people falling through the gap, yet many of the problems can be anticipated.

Also wanted to add the link to the Association of Young People’s Health with whom we are looking to work more closely this year.

http://www.youngpeopleshealth.org.uk

We will be participating on a series of national Master Classes and also collaborating on two national conferences : more nearer the time.

Talking of conferences ,last week I was at SAPC’s annual scientific meeting in Bristol.

http://www.sapc.ac.uk

It was a great success and the presentations were , as ever ,of high calibre although a scan of the published abstracts shows overall  a low percentage of research targeting the needs and  experiences of young people. 33/672  posters and oral presentations included data on the under 18 years old.

I intend to lead the group on a research project this year and to work with young researchers as active participants. We will be considering proposals when we next meet in September.

Until the next blog posting

Best wishes

Jane

jane.roberts@sunderland.ac.uk

My launch statement June 2011

The RCGP Adolescent Health Group would like to announce the appointment of their newly elected Chair: Dr Jane Roberts who begins her three year term this month. (June 2011).

Jane succeeds Dick Churchill who was Chair for five years, and who worked hard to consolidate the group’s leadership in promoting youth friendly general practice with  the ‘Getting it right’  initiative a major contribution to youth-friendly general practice This was initially developed by Dr Ann McPherson whose passing we have recently mourned  but whose memory is in the  AHG’s DNA and will continue to inspire the group and its activities. Dick also led on e-learning initiatives and  we hope to continue the work through the RCPCH’s review of the Adolescent Health E-Learning Programme .

Jane is keen to lead the group into a new phase of its life as the challenges to young people’s health continue. Despite the amazing vitality and optimism which so often characterizes youth and makes young people such fun to work with, teenagers in the UK today are faced with a number of challenges which pose particular threats to their emotional and physical well-being. The ubiquitous availability of  cheap alcohol and the dominance of alcohol in our cultural life has contributed to a rise in alcohol use, especially in the younger age groups, which is of particular  concern. Not unrelated, we have also seen  an increase in obesity rates amongst the 11-15 year olds and new cases of Chlamydia (although this may in part be due to improved screening techniques) (see www.chimat.org,uk for a summary of adolescent health in the UK today)  . 

Whilst adolescent health has benefitted from increased  government attention in the last decade the impact of child poverty has not lessened . The comprehensive Marmot review has emphasised the key task of reducing inequalities in social and economic circumstances which have a profound impact on health if we are to tackle the long term consequences of social disadvantage and injustice.We have all seen the human cost of disadvantage in our surgeries as ‘our poorest, most vulnerable and most disadvantaged children are the first to become parents themselves’(Gregoire and Hornby, 2011). 

There is much  that we can do in general practice and there have been a number of initiatives to demonstrate what is possible. The Kennedy report   places general practice at the heart of good primary care, ‘the single point of access’ (2010:9) but we lack data which accurately describes the current state of play regarding young people’s use of and access to primary health care. This will be a key area of activity for the AHG as it strengthens its relationship with CIRC and seeks to work collaboratively with colleagues in the Royal Colleges and with the clinical champions of the RCGP.

The group is open to new RCGP members and if you have  a particular passion and area  of expertise in adolescent health we would love to hear from you. Please contact Jane Roberts (Chair)

jane.roberts@sunderland.ac.uk or  Marian Davis (Vice –Chair)tom.mathias@which.net.

There will be a shortened version of my statement issued as a press release.

Please get back to me with any comments

Best wishes

Jane

Celebrating the amazing life of Dr Ann McPherson

The memorial service held for Ann was at Balliol College on Friday 10th June and here is a group of adolescent health group stalwarts: from L-R: Nicola Grey (our Pharmacy lead), Vice Chair Marian Davis, Frances Perrow (our media mogul), Dr Chris Donovan (Founding member) and Chair Jane Roberts.
It was a joyful occasions, apart from the tears, orchestrated by Jon Snow and illuminated by brilliant sunshine and the august surroundings of Balliol hall and grounds.The homilies to Ann and memories of her life conveyed a vivid collage of  a life lived with exuberance and energy.....and when we were all just about bowled over by what  one woman had achieve in her very full life her family brought us back to earth with stories  of the humanity and imperfection of their adored mum and grannie.
I think we all left bouyed up by some of Ann's characteristic joie de vivre and inspired to keep her spirit alive in all we wish to achieve for adolescent health in primary care.
A truly memorable day.

Best wishes

Jane

Gendered violence in UK teenage relationships

Continuing research tells us that gendered teen violence is a real and growing problem for young people in the UK. I was listening to ‘All in the mind’ BBC radio 4 on 31/5/11 to a report on research carried out by Dr Christine Barter at Bristol University. It was saddening to hear the testimonies of young girls, some as young as 13, talking about the violence and intimidation they had experience by their boyfriends, almost always older, and of the enormous difficulties they had in accepting there was a problem and prioritising their safety. Most agreed that at the time they were unable to see what was happening to them as something wrong. Issues of self-worth were mixed with a normalization of violence in  modern UK society.

We might be mindful of this phenomenon when consulting with young girls over contraception and sexual health.  

I wonder what others think and if anyone has something else to add on this subject?

 More information can be found at

http://www.homeoffice.gov.uk/crime/violence-against-women-girls/teenage-relationship-abuse/

http://bristol.ac.uk/sps/aboutus/sps-staff-details/barter/ Dr Christine Barter

This week we are preparing for the memorial service to commemorate the life and work of Dr Ann McPherson in Oxford on Friday 10^th. It  has been good to see the obituaries in the BMJ and the broadsheets as well as coverage from RCGP Chair Clare Gerada. She led a remarkably full life andher legacy to us is rich.

I will update the blog after the service.  

Best wishes

Jane