Introduction

General practitioners’ (GPs’) contribution to child protection is viewed as critical but the record of their performance is patchy. Research exploring the reasons for this suggests a number of factors are brought to bear, ranging from workload pressures and the inconvenient timing of meetings to some more fundamental concerns about GPs’ perceived marginality of their role and issues relating to confidentiality. These rationalisations are worth exploring at greater depth, since they may also reflect the more fundamental dynamics of how GPs conceptualise their core role, and of the wider political agenda for general practice within the NHS.

While operating from a position of relative managerial autonomy, and therefore isolated from the regimes which increasingly govern the activities not only of the semi-professions but also hospital clinicians, GPs have been increasingly involved in service planning and exposed to the competing priorities of the health service. This chapter will argue that the low priority GPs currently accord to child protection work is an inevitable consequence of the profession's model of practice. It will also be argued that child protection's absence from current priorities for joint working between health and social care, and its resulting displacement to the periphery of health care ‘business’, have restricted the responsibility for child protection to a few, key personnel. In terms of Benson's model, there are insufficient ‘resources’ (money or authority) to attract the profession to participate in child protection networks as well as a number of ‘superstructural dissonances’ inhibiting collaboration.

The expectation and the record

The involvement of GPs in child protection processes is seen as essential, not only to the identification and referral of children but also to the process of determining an appropriate response to the situation. The Working together guidance (DoH et al, 1999) is quite firm in its conviction that GPs are centrally placed not only to identify children at risk of harm but to contribute to the child protection process at all stages. General practitioners are exhorted to provide relevant information to the child protection conference (CPC), whether or not they are able to attend personally. Despite the importance given to their role in a series of policy declarations (Home Office et al, 1991; DoH and Welsh Office, 1995; DoH, 1998b; DoH et al,1999) and by other front-line workers (Simpson et al, 1994; Lupton et al, 1999b) research has raised questions about how adequately it is being discharged.