A proper kind of care in the community

9th February 1996 at 00:00
Michael Prestage joins the queue at a school surgery in Cornwall. Every lunchtime 15 to 20 pupils at Callington School and Community College in Cornwall head for a bungalow just beside the main entrance. Inside it's homely, with comfortable armchairs designed to make the place as unthreatening as possible. This is a health centre and the Callington pupils are going to see the doctor and nurse who are on duty each day.

Traditionally, doctors' surgeries are not accessible places for young people. Teenagers may be nervous about making appointments, embarrassed at being seen in the waiting room and generally fearful that the service won't be confidential. In a Cornish school with a 200-square mile rural catchment area, their difficulties are compunded by the lack of transport and access to surgeries. So the idea for TIC TAC (Teenage Information Centre, Teenage Advice Centre) was born.

Head Paul Buet had talked with Dr Jon Tilbury, a local GP and a school governor about different ways the school could serve its community. Dr Tilbury had also helped prepare material on sex education for the school's PSE programme and offered to come into the school one day a week to run a medical counselling service.

"It was then we realised," says Mr Buet, "what a range of issues young people were facing and that there weren't the resources available to help them. " At the same time the governors were rethinking the future of a spare building on the site. Rather than knock it down for a car park, they decided to recommission it as a medical centre.

Paul Buet is proud that his school offers confidential medical advice where there is such an obvious need. "It might be helping teenagers not to take up smoking or warning them of drugs. If we are helping young people to manage their lives better or preventing one unwanted pregnancy it will have been worthwhile."

Carol Ackroyd, a community nurse, says a survey by the local health centre had shown that teenagers were receiving the poorest service and under-using what existed. Some of them wanted to visit the doctor without their parents' knowledge but living in the country made this particularly difficult. "Often, the only time they had for appointments was school lunchtimes, but before Tic Tac it was difficult to leave the school premises," she says.

Since its launch last September with funding from the Cornwall Healthcare Trust, 500 children have come through Tic Tac's door to see one of a team of five doctors, or a community nurse or district health visitor, who take turns to be on duty. The pupils present a wide range of medical needs including sexual health problems and emotional difficulties.

A number of surprises have already emerged. One is the speed with which Tic Tac has been accepted by the pupil. After a quiet start, a few pupils started to visit, and there is now a regular flow of patients.

Another curious fact has been the number of boys using the service. Girls were expected to be in the majority but there is an even split between the sexes. Boys, as much as girls, are coming for guidance about health matters. They also have worries about relationships with the opposite sex, peer group pressure and smoking.

The school was initially worried about possible complaints from parents, but to date there has been just one. And that was resolved after a lengthy chat with Dr Tilbury. Because he is a governor at Callington, he has been able to work closely with teachers without the sense of an outsider moving in.

For the future, a co-ordinator will be appointed to give the surgery a permanent friendly face. Such continuity is considered to be an important step because the medical staff tend to change during the week. One boy patient who is attending regularly, is obviously plucking up the courage to ask something. Having the same reassuring face each day should help build pupils' confidence.

Dr Tilbury stresses that Callington doesn't have any particular problems. "It is a normal school where there just happen to be like-minded people who wanted to offer this service. There is clearly a similar need in other schools and I would like to think we could stimulate debate and get similar services provided elsewhere."

The numbers using the service are also making Tic Tac a victim of its own success. With only a lunch hour for consultations and a full surgery it is proving difficult to cope. Again the co-ordinator may be able to relieve some of the pressure or some pupils may be persuaded to visit the surgery practice out of school time.

Dr Tilbury said: "If we are really serious about health promotion and education this is where we ought to be making the investment. This is the time to achieve something useful and target people who are just setting out on a life time's ill health."

Targetting teenage health issues has taken on a new significance since the Government published its Health of the Nation document in l992, with improvements to aim at for the millenium. While the Callington initiative was not devised in response to that the targets had no new funding attached to them for which the Government was criticised it could be deemed a model of good practice.

The national targets were set to emphasise prevention rather than cure and one key aim was to halve the rate of pregnancies among teenage girls under 16 by the year 2000. Reductions in rates of smoking and consequent falls in the rate of lung cancer were another key aim.

This month new statistics show that for the first year in 10 years teenage pregnancies have fallen. Grassroots initiatives like the unique health service at Callington may be beginning to make a difference.

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