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In other words support is being offered to families by the WellFamily Project as part of a strategy to 127 THE PERSONAL IS THE MEDICAL prevent child abuse purchase 20 mg prilosec with amex. The vigorously ‘pro-active’ character of the project (the support worker chases up clients by telephone or letter if they do not turn up for appointments) is consistent with this preventive approach (and distinguishes it from other parenting projects which have high default rates) prilosec 10mg online. But have patients given their informed consent to this form of intervention recommended by their GP and carried out in the surgery? Project leaders emphasise the ‘independent’ and ‘non-statutory’ character of the ‘family support coordinator’ as a key to her acceptability and to the non-stigmatising character of the service (Goodhart et al discount prilosec 40 mg otc. But, in relation to child protection, this independence is entirely notional: under the terms of the Children Act and the ‘Working Together’ guidelines, workers in primary health care as well as in local authority social services have clear responsibilities to report instances of child abuse (Home Office 1991). The authors conclude that ‘whether stigma might transfer to the WellFamily Project remains to be seen’ but they are optimistic that ‘since the worker is not responsible for statutory child protection work she is unlikely to generate the same fears’. This confusion is unlikely to survive the first child protection case that arises and the transfer of stigma, over time, is inevitable. The government’s sponsorship of a series of initiatives to promote the teaching of parenting skills—the SureStart programme, the National Family and Parenting Institute and numerous subsidised voluntary organisations—has been criticised as an intrusion on parental autonomy (Fitzpatrick 1999). The notion that doctors should encourage, if not directly sponsor, such programmes is now widely accepted. Yet it marks a dramatic reversal of what was traditionally regarded as good medical practice. In an essay first published in 1950, the famous child psychotherapist Donald Winnicott insisted that ‘we must see that we never interfere with a home that is a going concern, not even for its own good’ (Winnicott 1965:132). He warned that ‘doctors are especially liable to get in the way between mothers and infants, or parents and children, always with the best intentions, for the prevention of disease and the promotion of health’. Winnicott, famed for his sensitivity to children’s mental states, was acutely aware that intruding between children and their parents, who are the most reliable guarantor of their interests, could have a destabilising effect. In a later essay, entitled ‘Advising Parents’, Winnicott amplified his views. He carefully distinguished the legitimate sphere of medical intervention—the treatment of disease—from giving ‘advice about life’, which was beyond their competence: Doctors and nurses [should] understand that they do not have to settle problems of living for their clients, men and women who are often more mature persons than the doctor or nurse who is advising. While offering information and support to parents, expert intervention diminishes the value of parents’ intimate experience of dealing with their own children. The intrusion of an external source of authority into the family undermines not only confidence but also accountability. Any third party intrusion between parents and children (Furedi 2000) is likely to weaken their own capacities to work through and resolve conflicts. Though motivated by a desire to provide help and support to families in need, parenting projects are likely to weaken parental authority still further. If GPs generally take on a wider role in family support and the promotion of parenting, they will be drawn into a more intrusive and authoritarian approach to their patients. The result will be damaging to doctor-patient relationships, and inevitably to professional status. The relatively high standing of general practice which makes it such an attractive base for New Labour’s moral engineering projects is a wasting asset, one likely to be expended very rapidly if GPs assume the shabby mantle of social work. It is rather ironic that, after seeking to take over the management of the social as well as the medical problems of the neighbourhood, many GPs complain of high levels of stress (not to mention a growing inclination among their patients to assault them). Following the scandal of the high death rates at the Bristol children’s heart surgery unit (culminating in disciplinary action against three doctors in June 1998), the Kent gynaecologist Rodney Ledward (struck off the medical register in October 1998 for gross negligence), and numerous less grievous cases of incompetence or corruption, the Shipman case provided further impetus to the drive to tighten administrative control over the medical profession (Abbasi 1999). In the closing months of 1999, a flurry of documents indicated the direction of measures for tougher action against rogue or ‘under-performing’ doctors and for closer regulation of the profession as a whole. The GMC published its long-awaited plans for the regular ‘revalidation’ of doctors based on an assessment of their fitness to practise (Buckley 1999). The RCGP and the General Practitioners Committee of the BMA jointly produced proposals on how revalidation could be implemented in general practice (RCGP October 1999, November 1999). Meanwhile the government’s chief medical officer, Liam Donaldson, issued a consultation paper on ‘preventing, recognising and dealing with poor performance’ among doctors, proposing ‘assessment and support centres’—immediately dubbed ‘boot camps’ or ‘sin bins’—for delinquent doctors (DoH November 1999).

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