Domhnall MacAuley: goodbye health visiting

Domhnall MacauleyBaby clinic was always the happiest and busiest afternoon of the week. After routine medical checks, there was a chance to share the excitement of the new baby and build on a relationship for the future. Our practice has had an open access baby clinic, where mums can see both the doctor and health visitor at one visit, for many years. But with patients drawn from two health districts, health visitors based in the other area had to cross an arbitrary boundary to see our patients who lived in their patch. Every so often a new manager would change the structure of the service, introduce new ideas like first parent visiting or geographical allocation but we tried hard to maintain the personal relationship with a named health visitor. It worked very well and, over the years, we worked closely to sort out some very complex problems and supported our health visitor colleagues when there were difficulties. At one stage, when they felt threatened by the erosion of their professional role, they asked if they could immunise our patients at the baby clinic in order to maintain their skills. It was great working as a team.

Today we received a letter from their manager (Director of Primary Care, Older People and Executive Director of Nursing) saying that her health visitors would no longer cross the boundary to provide a service in our practice. No consultation, no negotiation, no discussion.

For a practice that has always been a strong advocate of interprofessional collaboration and interdisciplinary learning (we set up the first Nurse Practitioner course with the RCN), this was disappointing.  In the past, we would have arranged another meeting and tried, yet again, to point out the benefits of working together. But, in today’s climate, it is increasingly difficult. The media image of GPs is such that no one believes we could possibly be thinking first about our patients and their care and, how working as a team in one centre, might make life easier for young mums. And our nursing colleagues seem increasingly determined to go their own way. They argue that they provide a clinic elsewhere. Mums, however, will still come to our baby clinic, worry about feeding and weight gain, ask about problems with breast feeding and changing formula, and bring sick babies and their siblings. For some, their own health visitor will not be there.

It is sad to see health visitors making themselves increasingly irrelevant. We enjoyed working with them. There were some wonderful women, outstanding professionals, and they taught us a lot. Once health visiting dissociates itself from direct first line patient care, I cannot see it surviving as an independent profession. They will, most likely, become a form of hybrid social worker. Give it five to ten years, perhaps less. We will miss them.