Concerns GPs are losing confidence to treat kids, as visit times drop
General practitioners are referring children more frequently to paediatricians, leading to blowouts in wait times and concerns that GPs are less confident in treating children with complex or chronic conditions.
Nearly 60 per cent of GPs reported they did not feel comfortable caring for a child with a complex or chronic condition, such as asthma, migraines or behavioural problems, according to research published in the Australian Health Review journal.
Lead author Gary Freed said the findings are consistent with data showing hospitals under pressure.
Melbourne’s Royal Children’s Hospital recorded a 25 per cent increase from 2010-2015 in new medical paediatric appointments, representing 10 000 extra visits per year — even though there has been no growth in the number of under-18s.
Professor Freed, of the University of Melbourne Centre for Health Policy, said the survey of 250 GPs was concerning, as more Australian children than ever live with a chronic illness.
“Australia has 1.5 million children aged 14 and under with at least one long-term medical condition, yet there’s been a sharp decline in extended consultations with GPs,” Professor Freed said.
"Extended consultations, which last above 20 minutes, are designed to assist in managing complex conditions.
"Extended consultations are absolutely necessary if these children are to receive adequate follow-up care from GPs, and the fact that these have dropped sharply suggests that shared care between GPs and specialists is not working.”
In a separate survey, paediatric specialists at two children’s hospitals in Melbourne felt GPs were referring patients without a clear purpose or enough information about how they had managed the child’s condition.
“This is alarming, especially when you consider that more than 70 per cent of paediatricians felt that they were taking on work that GPs should be able to manage themselves,” Professor Freed said.
Nearly two thirds of paediatricians observed that parent requests were often behind necessary and unnecessary referrals.
“This could be because some parents feel GPs don’t appreciate the gravity of their child’s condition or that the GPs themselves lack knowledge and confidence,” Professor Freed said.
“Either way, this is putting a strain on a system already affected by specialist shortages, and raises concerns that GPs aren’t equipped for the crucial role of determining which requests are justified in the child’s best interests.”
Professor Freed said action was needed by government and GP training bodies.
“The relationship between primary and secondary care is being left to chance, because it falls between levels of government, even though we know the costs to the public purse of poor coordination are considerable," he said.
“We need more paediatricians, but we also need more GPs trained specifically in paediatrics.”