DR DICK CHURCHILL
BM BS MSc DM FRCGP
Clinical Associate Professor of Primary Care
Chair, RCGP Adolescent Health Group
Dick is an academic GP in Nottingham who is committed to promoting better healthcare for young people in primary care, particularly in the areas of sexual and mental health
One of the most challenging issues confronting anyone working directly with young people is how to deal with the range of sensitive health-related issues that can arise – whether that's talking about relationships, sexual health, emotional problems, alcohol and substance misuse, or simply embarrassing spots.
For practice managers, the challenge is even greater, as before staff can begin to deal with these issues they must first look at how to build confidence among young people so they feel able to walk into a clinic and ask for help.
"You're Welcome" has been developed by the Department of Health to provide explicit criteria by which services can judge their "youth-friendliness". It provides best-practice resources and a simple self-assessment toolkit, available at the Department of Health website (see Resources).
"You're Welcome" is complemented by other initiatives, such as the new educational e-learning package on adolescent health and a new edition of the RCGP "Confidentiality Toolkit" for general practices, shortly to be published. The Association for Young People's Health (see Resources) is also supporting health professionals who care for young people, and since November it has included a new resource and discussion forum specifically for GPs: "GPs4YP".
Along with "You're Welcome", these initiatives are all designed not only to help primary healthcare professionals make their services "young-people friendly", but also to ensure that staff feel equipped to deal with the challenges they meet.
The government is investing £4.5m over the next three years to help the NHS continue to support the national roll-out of "You're Welcome", which will ensure that all young people – regardless of background or where they live – are able to access health services that are tailored to their needs. This year, the first 35 local health services from across England were awarded "You're Welcome" status for achieving the criteria.
GP practices, sexual health services, pharmacies, hospitals and school-based health services are now being encouraged to adopt the framework to assist them in building upon existing good practice and to commission the delivery of new initiatives. These services are all working towards a shared vision that by 2020 all health services regularly used by 11-19 year olds will meet the 10 criteria themes of "You're Welcome".
Using "You're Welcome" is a great way to stimulate discussion between members of primary care teams and to support them in making positive changes, with the assurance that such changes are consistent with those being promoted across the whole of the NHS.
Staff motivation is key, and these quality criteria play a crucial role by developing teamwork and encouraging and resourcing staff who may already feel burdened, ill-equipped or overwhelmed by situations or workload.
For me, I think building trust between young people and health professionals is probably the most important step in helping them to access healthcare. "You're Welcome" can assist with this by ensuring that all practice staff are adequately trained, that policies reiterate good practice principles, and that any breaches of confidentiality or privacy, however small, are taken seriously and investigated, with a view to changing procedures if necessary.
Before we, as health professionals, can work on building that trust, we must look at ways to make our health services more inviting to young people. "You're Welcome" can help practice managers to identify the priority areas they need to consider when taking stock of their own practice and looking at how to make it more accessible to young people.
It is important not to be put off by the potential scale of changes that could be implemented. Often, even just small, simple changes can have an impact, such as having informative posters in the waiting area or simply ensuring that young people who present themselves to a clinic are greeted by a smile from staff, encouraged to come in and made to feel safe and welcome.
Ultimately, the only way we're going to find out what young people like and dislike about visiting a health professional is by engaging with them. Some clinics and surgeries have been working on this by holding focus groups both with young people who visit GPs and those who choose to stay away.
As young people are exposed to so many forms of media and advertising messages, there is debate as to how best we communicate information about new health initiatives to them. We need to convince young people that their issues will be listened to and taken seriously. I think this is best achieved by engaging with the local community.
To raise young people's trust, we need those within the community to promote health services as being "young-people friendly". We need to take the message to young people, perhaps by visiting schools and youth groups for example, to take a relational approach – and the more "word of mouth" we can generate, the better the chance we stand of getting them involved.
While there is some evidence to show that the practices with more female doctors, younger doctors and more nurse hours have lower teen pregnancy rates – suggesting that perhaps these practices feel more accessible to young people – I think it is more important that clinicians demonstrate genuine interest in the young person, which will encourage them to come back again.
Practice nurses and GPs often tell us that they have a fear of "finding out too much" when it comes to dealing with young people. These concerns are largely around ethical and legal issues, such as the age of consent and whether it's appropriate to consult and treat patients of a certain age without a parent or carer knowing. Many of the new resources help provide guidance on these issues with the aim of improving health professionals' confidence and thus willingness to engage.
It's really important for health professionals to recognise when they need to scratch beneath the surface and look at the underlying reasons as to why a young person may have come. A young person may arrive at a clinic with what may seem to be a fairly trivial matter, but it must be treated seriously, sensitively and with further questioning, as, in many cases, they may need support with more than just their physical health concern.
As questions around youth health become increasingly common, "You're Welcome" and other support initiatives are also establishing online web tools where GPs and practice managers can share feedback and information around good practice both locally and nationally. By establishing these forums and looking at performance and quality of service, real steps are being made to ensure that we're building consistency around delivery.
We're not there yet, but we are making real progress towards becoming a truly young-person friendly health service. We need to build a comprehensive set of best-practice guidelines for staff to have the confidence to deal with young people, and I firmly believe that once "You're Welcome" is fully rolled out, young people will develop greater trust in our delivery of health services, and, as this increases, so too will the chances of them continuing to seek appropriate health advice and help later in life.