| Abstract: | This study was conducted in two related but separate phases. Phase one compared the frequency and type of participation by general practitioners and health visitors in child protection case conferences. Two hundred consecutive case conferences involving 83 general practitioners from 33 practices were independently reviewed and scored to assess the level of general practitioner and health visitor participation, whether by written report and/or by attendance. Health visitors showed a far higher level of participation in case conferences than general practitioners and their attendance was more often rated essential by the social worker than that of the general practitioner. There was no evidence in those cases where social workers rated the general practitioner's attendance as essential that this resulted in increased general practitioner participation. General practitioners were equally unlikely to participate in initial, first review and subsequent review case conferences. Most importantly, general practitioner participation/non-participation was not related to length of notice given. In phase two, 76 general practitioners from the sample of 83 were interviewed in order to elicit factors underlying their decision on participation in child protection case conferences. Personal and practice characteristics and attitudes towards the case conference and towards social workers were examined and subsequently analysed. No significant associations were discovered apart from a link between previous training in child protection and a less negative attitude towards communication with social workers and the belief that the general practitioner's participation in the case conference helps him/her in the subsequent management of the case. Personal contact between local social workers and the primary health care team was seen as likely to be helpful in the establishment of a climate of trust which would facilitate the flow of sensitive information in both directions. Health visitors were often regarded by general practitioners as fulfilling the role of delegate to the case conference without having any formal remit to carry out this task. |
