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C:\Documents and Settings\Sue Rivers-Brown\Local Settings\Temporary Internet Rles\Content.IES\6DJK5ONM\RCGP LMC Joint position

INVESTOR IN PEOPLE

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Bedfordshire & Hertfordshire Local Medical Committee

Working in partnership tor excellence In kseneral Practice
Hertfordshire Subcommittee
Chairman: Dr J E Freedman
Chief Executive: Dr Peter Graves
Director of Operations: Viv Seal
LMC/PCT Liaison Manager: Rachel Lea
Telephone: 01438 880010 Fax: 01438 880013
Email: petergraves@bedshertsImcs.org.uk
Website: www.bedshertslmcs.org.uk
The Shires, Astonbury Farm, Aston, Stevenage, Heds, SG2 7EG

ROYAL COLLEGE OF
GENERAL PRACTITIONERS
Registered Charity Number 223106
Bedfordshire & Hertfordshire Faculty
Whitehill House,
6 Union Street, Luton, Beds. LU1 3AN
Tel/Fax 01582 404088
Email - bedsandherts@rcgp.org.uk
7 August 2006

Dear

Re The Future of Health Visitors in Hertfordshire,

The Beds and Herts Faculty of the Royal College of GPs and the Beds & Herts LMC are so concerned about the progressive diminution of community staff, and in particular Health Visitors across Hertfordshire, that we are currently doing a joint piece of work to extol the virtues and highlight the essential roles that GPs feel Health Visitors fulfil.

Attached is a list of research papers written over the last 8 years supporting this stance.

We are very well aware that the PCTs are in "Special Financial Measures" but we believe that any policy which freezes Community staff and Health Visitor posts or reduces their numbers will have a negative impact on the health of our children, and on public health overall.

It is clear from the evidence, some of which is listed below, that the roles of Health Visitors ranges from improved uptake of vaccinations to early intervention of child abuse, from better uptake of breast feeding through to improved management of Failure to Thrive.

The Government's white paper, Our Health, our care our say: a new direction for community services, (2006) sets out a clear agenda for the shift of resources into community services. It highlights the importance of healthy living starting "at the earliest opportunity" and stresses that "health and development in early childhood are crucial influences on health and other
outcomes throughout life..." Health Visitors are essential members of the primary health care team ensuring that parents and families are supported and advised on ensuring those early opportunities are taken.

The local faculty of the RCGP and the LMC strongly believe that it would be short-sighted, to say the least, to allow numbers of Health Visitors to continue to decline, putting some of the most vulnerable children in society at serious risk.
Like the rest of the NHS, we understand that community staff must critically assess the way they work, ensuring that they work in the most effective and efficient ways, in order that resources are targeted to where they are most needed. The future work of the group will take this into account but will robustly support the maintenance of strong community teams working to ensure continuity of care and close collaboration for the benefit of all patients, but particularly children.

We look forward to presenting the paper later in the year.

Dr Frances Cranfield	Dr Peter Graves	Dr Jonathan Freedman
Chairman of	Chief Executive	Chairman
Beds & Herts Faculty of RCGP Beds & Herts LMC	Hertfordshire LMC Sub-Committee
Cc PCT CEOs and Directors of (Community) Nursing Pearse Butler and Director of Nursing at SHA Local Herts and Bedford MPs
LMC Reps Beds & Herts
Health Visiting and Child Health: evidence-base supports maintaining the service

The sites were accessed on 16th July 2006; over 8500 articles were found, and were limited to English and UK articles.

1.	Reduce health inequalities (Reading and Allen 424-30;While 129-36)

2.	Improve parenting (;Patterson et al. 472-77;Stewart et al. 519-25), including breastfeeding (Gordon 203-04)

3.	Early detection of developmental problems (Chakrabarti and Fombonne 1133-41;Johnson and Ashurst 841-45;Lambert et al. 11-13;Williams and Holmes 34-46)

4.	Improve uptake rates for immunisation (Clark et al. 196-98;Emond et al. 150-57;Webb et al. 210-13)
5.	Early detection and management of postnatal depression (MURRAY et al. 420-27;Murray et al. 131-37)

6.	Promote interprofessional and inter-agency communication, especially in child protection matters (COOPER and PENNINGTON 599-613;Crisp and Lister 656-63;Gilardi 225-27)

7.	Reduce utilisation of General Practitioner services (Cowley 199-201)

8.	Injury prevention (Kendrick et al. 39-45) (Dearlove and Illingworth 507-10;Kendrick et al. 366-70;Kendrick et aI. 980-83)
1.	
There is also data supporting the general benefits of HVs for General Practice(Steel, Reading, and Allen 121-28); there is in fact a shortage of HV provision!
Further evidence:

1.	Positive effects on breast feeding

The effect of health visitors on breastfeeding in Glasgow Tappin DM, Britten 3, Broadfoot M, McInnes R. Int Breastfeed J. 2006 Jul 5;1(1):11

2.	Government recognises importance of Health Visitors in Public Health

Refocusing health visiting -- sharpening the vision and facilitating the process Carr SM 3 Nurs Manag. 2005 May;13(3):249-56
3.	Health Visitors are the best source of advice for second dose of MMR

Second dose of measles, mumps, and rubella vaccine: questionnaire survey of health professionals Petrovic M, Roberts R, Ramsay R BMJ 2001;322:82-85 (13 January )
4.	Essential role of Health Visitors in managing failure to thrive
Health visitors can manage failure to thrive BM], Aug 1998; 317: 0
5.	Access to health advice by difficult to reach, vulnerable groups for example single parents,

Single parents need home visits by health visitors BMJ 1998;317:1390 (14 November )
6.	Early intervention to prevent child abuse
The Effects of Early Prevention Programs for Families with Young Children at Risk for Physical Child Abuse and Neglect: A Meta-Analysis Geeraert L, Van den Noortgate W, Grietens H, Onghena P. Child Maltreatment, Vol. 9, No. 3, 277-291 (2004)

Sourced by:
Frances Cranfield, Chairman of Beds & Herts Faculty of RCGP David Lewis, Secretary of Beds & Herts Faculty of RCGP Peter Graves, Chief Exec Beds & Herts LMC