Our view

May 06 - UK: GPs concerned about keeping parents at bay

With reports of Britain’s teenagers dealing with growing problems of drugs, poor diet and underage sex, GPs admit they’re becoming increasingly concerned about keeping parents in the dark about teenagers’ health matters.

New research reveals that nearly one in three (30%) GPs are calling for a review of current patient confidentiality guidelines to give parents of under-16s the "right to know" on health matters including pregnancy and sexual health. Over 90% of parents believe they have the "right to know" about such matters.

Figures from Norwich Union Healthcare’s latest "Health of the Nation Index", a study of 250 GPs nationwide, reveals the issues GPs believe parents of young people should be informed about:

1. Drug misuse - 38%
2. Alcohol misuse - 37%
3. Eating disorders - 32%
4. Sexual health matters- 18%

Under current confidentiality guidelines, GPs are required to keep quiet about all teenagers’ health matters¹. Parents may therefore be unaware of the following²:

• If their 14 year old son was being treated for a sexually transmitted infection
• If their teenage daughter was prescribed the pill despite potential dangers of family medical history (eg inherited tendency towards blood clots/thrombosis)
• If their 15 year old daughter was having a termination
• If their 13 year old son visited his GP about regularly drinking half a bottle of vodka in a single sitting.

However, one-in-25 (4%) GPs feel so uncomfortable with the current situation that they have already breached confidentiality guidelines and informed parents of teenage patient’s health problems before gaining prior consent from the patient, potentially risking legal action under English common law.

London GP and member of the GP panel, Dr Ann Robinson, comments: “GPs will always encourage teenagers to involve a parent or responsible adult but some teenagers refuse.

"Involving parents can be crucial for a number of reasons: young people need emotional support when undergoing treatment; parents may need to inform GPs of important family medical history; GPs need to understand teenage patients’ backgrounds as problems such as depression can impact on the whole family; finally, solutions to problems - especially lifestyle problems - must involve the whole family.

"The research suggests that parents and GPs want a more open dialogue which addresses the teenagers’ needs first and foremost but also doesn’t shut parents out.”

GPs seem unconvinced by claims that, without guaranteed confidentiality, teenage patients will have nowhere to turn for impartial advice and support.
Almost one-third (29%) of GPs believe that granting parents the right to know about treatment or advice their teenager is receiving will have no detrimental impact on levels of teenage pregnancy in the UK. Almost one-in-five (17%) believe it could have a positive impact on these levels.

The same is true of sexual health matters, with the same number (29%) believing that granting parents a right to know would have no detrimental impact on the level of STIs among teenagers in the UK and 17% believing it could even reduce the number of cases.

Research suggests that the vast majority of British parents support GPs in this view. They believe they have the right to know if their child receives advice on any matter relating to the following:

• Eating disorders 94%
• Alcohol misuse 93%
• Drugs misuse 93%
• Sexual health 86%

To help parents address difficult subjects including sexual health, drugs and alcohol with their offspring, Dr Ann provides the following advice:

• Do your homework. Speak to your GP, the school nurse or local family planning service to find the most teenage friendly place that your son or daughter can go for expert advice. Then give them the phone number.
• Keep channels of communication open. The most natural way to communicate is whilst doing something you both enjoy; a swim or short jog or perhaps an evening out at the cinema.
• Stay positive and be loving and supportive. There may be aspects of your teenager’s behaviour that are challenging, but they need to keep being told that it doesn’t challenge your intrinsic love for them.
• You are the parent, not their friend. Teenagers need boundaries. Pick your fights carefully.

Dr Doug Wright, clinical spokesperson for Norwich Union Healthcare, continues: “Patient confidentiality is sacred and the trend for GPs to breach guidelines on the subject is a measure of the complicated nature of managing young people’s health issues.

"GPs stress the importance of clear communication between parents and their teenage children so that parents become aware of the advice and treatment that is given by a GP to their children.

"Honesty and trust will give parents and teenagers the very best chance of dealing with these issues.”

The Health of the Nation Index is a bi-annual research programme tracking the views of the UK’s GPs.

Now in its fourth year, the latest report forms the seventh tranche of research undertaken since the Index was first launched in April 2003. Highlights include:

• 44% of GPs have avoided raising the issue of weight with obese/overweight patients
• 20% of GPs have withheld treatment because of a patient’s unhealthy lifestyle
• 44% of GPs would be prepared to work more flexible shift patterns to ensure surgeries could offer longer opening hours
• Contentment at work for GPs remains steady, with 51% of doctors expressing high/very high levels of job satisfaction
• GPs believe that faster and more reliable diagnostic services would most improve patient experience of the health service, followed by shorter waiting lists and longer appointments with GPs

Roger Taylor, research director at Dr Foster Research Ltd who carried out the research, said: “The findings show the difficult personal and moral challenges that GPs face in their daily practice – raising difficult personal issues with patients, deciding whether or not to refer patients with poor lifestyles and respecting the confidentiality of children.

"But despite these difficulties GPs display high levels of satisfaction with their work and, encouragingly, many are willing to work more flexibly to improve patient access to services.”

Full details of the Health of the Nation Index report can be accessed at www.healthofthenation.com.

-ends-

Media contacts:
Chris Lauwerys or Melanie Corbett, Lexis Public Relations on 020 7908 6488

Norwich Union Press Office contacts:
Cheryl Cox: 07800 695 275 or 01904 452617

Notes to editors:
¹GPs are required to keep quiet about teenagers’ health matters unless the teenager agrees to involve a parent or responsible adult, is unable to understand all the issues or there are child protection issues.

²Whilst there is no lower age limit - meaning children as young as 13 can be treated without their parents knowing - Department of Health guidance stresses the importance of confidentiality for under 16s. Health professionals must take the time to explore whether individual cases involve coercion or abuse. Where there is cause for concern the case would be referred through child protection procedures. The DoH has also developed guidance in the wake of the Victoria Gillick case.

The Gillick case established that health professionals are justified in giving contraceptive advice and treatment to under 16s without parental knowledge or consent provided that certain conditions are met.

Doctors and other health professionals are expected to follow the criteria outlined by Lord Fraser in 1985 in the House of Lords' ruling in the case of Victoria Gillick v West Norfolk and Wisbech Health Authority and Department of Health and Social Security. These are commonly known as the Fraser Guidelines:

• The young person understands the health professional's advice
• The health professional cannot persuade the young person to inform his; or her parent or allow the doctor to inform the parents that he or she is seeking contraceptive advice
• The young person is very likely to begin or continue having intercourse with or without contraceptive treatment; unless he or she receives contraceptive advice or treatment, the young person's physical or mental health or both are likely to suffer
• The young person's best interests require the health professional to give contraceptive advice, treatment or both without parental consent.

Case studies available on request.

Norwich Union Healthcare commissioned Dr Foster Research Ltd to conduct research amongst approximately 250 practicing GPs from across the UK in September 2005.

All figures, unless otherwise stated, are from YouGov Plc. The total sample size was 2,598 and fieldwork was undertaken between 12th and 18th April 2006. The survey was carried out online and the data is weighted to be representative of the GB population (aged 18+).

About Norwich Union Healthcare

• Norwich Union Healthcare was founded in 1990 as the healthcare arm of Norwich Union and now provides a range of income protection and private health insurance products that cover over 870,000 lives. It is one of the largest providers of income protection and private health insurance in the UK.
• Norwich Union acquired Occupational Health provider, Private Health Care, in October 2005. We now offer an extensive range of occupational health services to corporate clients. These services are delivered by Norwich Union Occupational Health Ltd.
• Norwich Union Healthcare is authorised and regulated by the Financial Services Authority and is a member of the Association of British Insurers and the Financial Ombudsman Service.
• Norwich Union’s news releases and a selection of images are available from Aviva’s internet press centre at www.aviva.com/media.

About Dr Foster Research Ltd

• Dr Foster Research Ltd is the leading independent authority on healthcare quality in the UK. Its information can be accessed via publications such as the Hospital Guide and online at www.drfoster.co.uk.
• Dr Foster Research Ltd is the sister company to Dr Foster Intelligence, which provides expert analysis to the NHS.
• An independent Ethics Committee with substantial powers to enforce editorial and research integrity oversees the organisation.
• Further information is available at www.drfoster.co.uk or direct from Dan Collins, Client Services Manager, DF Research, 17 St Helen’s Place, London, EC3A 6DG.