Dr Ralph Wiles Chairperson

The country’s general practitioners have rejected the Minister of Health’s claim that they are reporting child abuse to ACC but not to CYFS, and that GPs did not follow “guidelines” issued two years ago.

“The ‘guidelines’ to which the Minister refers are not in fact guidelines at all,” explained Royal NZ College of General Practitioners Chairperson Dr Ralph Wiles. “What the Ministry of Health issued in 1998 were essentially guidelines on how to develop guidelines. In other words, general practice was asked to devise a set of protocols without any support or funding with which to do so. We’re not disputing that the Ministry’s booklet provides a framework within which guidelines could be drawn up. But the Minister is either unaware of the process or chooses to ignore it if she can claim that that booklet provides a set of protocols for general practitioners to follow. It does not.”

Dr Wiles compared the process with that undertaken last year to produce “Guidelines for Primary Care Providers: Detection and Management of Young People at Risk of Suicide”. “That process was properly funded by the Ministry of Youth Affairs. The College undertook and enormous amount of research and consultation with the profession and the broader health community to arrive at a set of protocols which have widespread acceptance among GPs. And GPs are confident in the referral mechanisms recommended in those guidelines, because they arise from successful past interventions by GPs themselves.

“That’s very different to producing a booklet detailing how to arrive at a set of guidelines, but then doing nothing about funding the writing of them. General practitioners are not employed by the government and not funded directly like, say, HHSs. You can’t simply issue a directive or a suggestion and expect more than 3000 individual GPs in this country to somehow arrive at a conclusion without funding the consultation and drafting process, and the dissemination and training that follows. After publishing the guidelines on youth suicide intervention, the College undertook a lot of work training trainers who then went into practices and trained doctors and practice nurses. That too was funded by the Ministry of Youth Affairs,” he noted.

We’re pleased the Minister recognises that it takes millions of dollars to adequately train a general practice workforce in a complex skill such as the detection, management and reporting of potential child abuse,” Dr Wiles said. “But if this is the case then where, we have to ask, were these millions to have come from before her commitment last week? And in the absence of that expenditure, how were GPs to receive such training?”

The College also took issue with the Minister’s claim that GPs were “claiming money from ACC for children who have been abused, but not using the guidelines for reporting”. “Setting aside the fact that no such guidelines exist,” Dr Wiles said, “the implication that general practitioners are willing to overlook child abuse while profiting from it is repugnant.

“We would be interested to know how the data was arrived at, since ACC Read Codes, which categorise claims under hundreds of different classes of injury, no more have a category for ‘child abuse’ than they do ‘sporting injuries’. The classification is far more precise but deals only with the medical nature of the injury – for instance it may be a fractured or broken bone or contusions to the skin. There is some questioning as to where the injury occurred – at work, at home, etc – but nothing that asks a GP, or anyone else, to pinpoint cause. ACC’s role in child abuse, other than is paying for treating specific injuries which may have been caused in that way, is restricted to providing counselling for previous victims. It’s therefore a distortion of the facts to make a claim in terms such as those used by the Minister.”

Dr Wiles emphasised that the College was keen to work with all groups to promote a healthy environment for NZ’s children. It is currently working with CYFS to draw up guidelines for general practitioners confronting what they suspect may be child abuse, and will take an active role in the conference organised by National MP Bob Simcock to bring the various parties together to work on the issue.

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Contact: Dr Ralph Wiles (07) 886-5239 or (021) 658-564 or: Rex Widerstrom (04) 496-5962 or (025) 549-637

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