Boarding & registering with school GP issues

[ohapples]

We are having trouble with the school GP and trying to get nhs care. We are not rich and there’s no private insurance. Nhs is our only route.

Does anyone know, When these boarders are registered with the school GP. Does the GP get funding for them like a normal family GP? Am I wrong in expecting the same care he would get from our family GP?

The school med centre has told me to contact the GP but the GP is ignoring calls, emails and requests for copies of letters. It’s been five months now.

From about 13 a child would generally be considered to be Gillick Competent and therefore entitled to the same level of confidentiality regarding any treatment as an adult unless there are safe guarding concerns. I know that some school health (senior schools) inform parents that Jonny/Amelia has attended but it is bad practice and breaches the NMC/GMC code of conduct. The school nurse/GP can ask the child for permission to inform the parent(s) that they’ve visited the school medical centre and received treatment but shouldn’t just assume that consent has been given to share information. In practice most children at boarding schools either contact their parents themselves either via their own mob or usie the school medical centre phone either calling themselves of getting staff to call on their behalf
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The problem in a situation like this, is that not all 13/14 year olds will think of these things themselves. A teenager with earlier experience of illness and medical care with their parents around/notified, is even less likely to think "must make sure I ask someone to tell my parents what is going on". I know my own 13 yr old would absolutely "assume I knew" or "assume I'd been told" - we're really having to work on communication skills here ... But intellectually he would readily be judged competent in many circumstances.

It sounds like there is a mixture of issues around who is responsible for communicating what, and the school medical centre need to think about whether they should be asking "is this something you would like us to tell your parents about", or putting clear notices around saying "please ask if you want us to communicate with your parents", or something.

I’m not sure parents need to be informed every time a pupil attends the school medical centre as much of it will be routine stuff; coughs colds minor sprains etc.

I would write direct to headmaster complaining that the school medical Practice is not providing proper holistic medical care for your son and is this failing it’s contractual obligations. Ask for a meeting with the head on the day you return your son.
Although the med centre is at fault, they are reliant on the school for their patient list. You complaining doesn’t hurt them; the only person who can put pressure on them where it hurts is the head. Totally unacceptable for your son to not receive appropriate ongoing medical care.

You can't assume Gillick competence of a thirteen year old.

A HCP would have to assess the individual child to see if they have capacity to consent or decline treatment.

What is more likely here is that the school is acting in loco-parentis.

The school then have an obligation to inform parents of medical intervention in a timely way.

The lack of communication from school is one issue.

The GP refusal to refer is a second. However, depending on the condition and local referral pathways, it maybe necessary to refer to secondary care in order to access a tertiary centre such as GOS.

Most boarding schools will automatically assume a year 9 child is Gillick competent.

In practice most of those individual children may well be Gillick competent.

You can't assume it though. The law requires HCPs to make an assessment of competence.

You’ve also got to ask what are they informing the parents about? A child coming to the school medical centre with a the symptoms of a cold? Why routinely inform the parents? They probably don’t inform HMs either. Something more serious e.g. taking a child to the local A and E with abdominal pain ?appendicitis IME the staff in the medical centre would say “have you let your parents know? Do you want me to call them?” A trip to a minor injuries unit for a swollen finger to exclude a fracture; many children wont rush to inform their parents who may be at work etc and will wait for the results before ringing them.

At our local boarding schools all boarders registered with local GP. Entitled to all usual nhs services. Some schools pay an additional fee for a designated medical officer who will do surgeries at the school but increasingly less and less do this both due to pressure on Drs time and availability and school finances, and just book appointments in surgery as usual. It sounds like the problem is with the GP who should be dealing with the issue in hand with a further nhs referral if appropriate.