More on Jabs I'm afraid

I noted in my previous Blog that vaccination rates were low in Totnes.

The PCT has now come up with some figures to show this more clearly.

They have listed the 29 towns within Devon PCT and show us the vaccination rates for them all.

Now, with Totnes' traditionally "alternative" population vaccination rates had been low for a long time.

The PCT a few years ago looked at this and thought the obvious explanation for low rates was the nursing staff. Clearly they weren't promoting vaccination hard enough, or, somehow, in the process were putting people off.

The nurses went and had special training til the PCT were happy with their performance.

Needless to say vaccination rates didn't change as a result, because it wasn't the nurses; it was of course the special population we serve.
in 2007/8 the proportion of children in Totnes who had been given an MMR by the age of five was only 66.7%.
Other towns in Devon with similar, or larger, populations of under 5's were getting rates much higher- eg Bideford- 90%, Dawlish 93%, Tavistock 93.5%.
Similar with DTP/HiB; Totnes 69%, Kingsbridge 96%.
I personally think it is shocking.
People come to live here for a number of reasons I think.
Many people cite living in the area because it is a good place to bring up your children.
If good now means exposing them to the risks associated with dangerous viral illness then I would take issue with it being safe. Safety can, of course be seen in two ways- people clearly see the risk to their child and weigh up the risk of their child suffering a complication of Viral Illness with the perceived risk of the jab. For an individual child the risk of a complication from a virus is indeed low. Get an outbreak and loads of kids in our playgroups and primary schools go down with the viruses, then some of them are going to suffer complications. The risk of a child or two getting very ill in the town in an outbreak is distinct, so from my perspective as a GP it is important to keep on about this I think.

My kids are now more exposed to the threat of illness because others have chosen not to get vaccinations. I don't particularly like to be dictated to, but I accept it where the overall benefit is clear. I am often content to see people go against guidelines and so on where they can make a cogent case to support their variance. I do mind a lot however when vaccinated kids such as my own go down with illness due to the low population, or herd, immunity.

Health Visitors at Leatside

The Health Visitors have been, since we moved to Leatside, an integral part of the healthcare provision in Totnes. They (Carol Zollo and Jan Laverty) work in and are based in our building, though are employed by Devon PCT, not directly by us.

In order to work effectively together, long ago it was decided that the Health Visitors would use our computerised records as well as us. This meant that the doctors could see pertinent Health Visitor records regarding children who might be having difficulties at home for example. Similarly, if the Health Visitor was faced with a child with problems, they would be using the same file system as the doctors, so would instantly see any important medical details or records of attendance at casualty and so on.

Some years ago we were using Palm Pilots to record Home Visit Consultations, and Carol Zollo used this system extensively in her Health Visiting role because of the benefits it brought to working together as a team.

Since Devon PCT formed out of the various smaller PCTs a while back they have been looking at standardising provision of services across Devon. (This doesn't include Torbay or Plymouth which are separate) In their terms standardising seems to be in a couple of important areas. One is in the number and experience of Health Visitors serving the population. Of course they will be standardising to the areas with the lowest provision. When Carol retires she will be replaced by a less experienced nurse. (Less expensive) The other important area is in record-keeping. Health Visitors had been told that they should now be using a standardised paper record for documentation.So that is what they have been doing, duplicating the record on our computer because of the obvious benefits to care. Since the inquiry into Baby P concluded that sharing of information was key in Child Protection it does seem obvious doesn't it. Well, not that obvious apparently. Devon PCT has now told the Health Visitors that they must not now enter information onto GP computer systems.

I can't think of a good reason why the information should not be duplicated. Come to think of it I can't think why the records have gone from being computerised (searchable, auditable) to paper-based. In the modern era the different GP computer systems share a common information standard so if a child moved practices the information would move to the new computer. I'm quite baffled.

Oh, and the Parenting group they've been running- Time Out for Teenagers, as well as the baby-massage sessions are to stop.

Clearly if there are practices doing things that others aren't, then standardisation would mean making all the practices do the extras. As this would be too expensive, they will be standardising on the lowest common denominator Health Visitor practice.

So innovative advances in practice will be removed.

Watch this space for the next instalment. The District Nursing team will doubtless be asked to go the same way before very long.

One more thing- if they choose to standardise GP funding across Devon we'll be OK as we are already one of the lowest-funded practices in Devon. We get very nearly half the funding of the most-funded practice in Devon- £62.90 vs £112.83 per "weighted" Patient.