Friday Afternoon Solutions

The problem – A potentially ‘at risk’ pregnant teem with Chlamydia

Every GP at some stage of his or her career will have one of those ‘Friday afternoon before a long weekend’ consultations. If it hasn’t happened to you already, it will. It’s a GP’s rite of passage. You will know it when you see it, because the consultation will manifest as a tangled web of clinical and medico-legal issues, often concerning a minor and usually triggering concerns about mandatory reporting obligations. Sometimes there is the added bonus of a public health concern. This consultation had it all.

On this particular Friday afternoon, the GP was fully booked and seeing walk-in’s. His next patient was a young woman of 15 who was around 15 weeks pregnant and positive for Chlamydia. She was accompanied by a male who looked to be in his 30s. To complicate matters further, on this day, the IT system was down. So even though this wasn’t her first visit, it was difficult to establish a reliable patient history. The man who accompanied the patient claimed to be the father of the baby, and insisted on remaining with her throughout the consultation. It was unclear whether the mother wanted him to be there. She was vulnerable and scared, and habitually turned to him to validate her responses to the doctor.

This was tricky. It was a concerning consultation; this was potentially an ‘at risk’ mother and unborn child. In light of the positive Chlamydia test, also at risk were the previous sexual partners of the patient. The alleged father refused to be tested.

This is the exactly the type of scenario to happen on a busy Friday afternoon. So where do you start when a situation like this presents itself?

 The NSW Child Wellbeing Unit

Changes in the legislation have thrown GPs a lifeline. The NSW Child Wellbeing Unit is a telephone support service staffed by child protection professionals who are proficient in the assessment and management of risk to children and young people.

The service can:

• Assist you to identify appropriate actions and referrals in response to your concerns;
• Give you relevant information held about past child protection related concerns;
• Provide guidance around how to raise your health safety and wellbeing concerns with parents.

 What has changed?

The Children and Young Persons (Care and Protection) Act 1988 (the Care Act) has been amended to allow all registered medical practitioners and general practice nurses access to the NSW Child Wellbeing Unit. The objective of this amendment is to bring certain private health professionals into the Care Act’s information sharing and alternative reporting schemes. As a result of the amendment affecting 27A of the Care Act, all registered medical practitioners and general practice nurses can now consult with and report to the NSW Health Child Wellbeing Unit if they have concerns regarding the safety welfare or wellbeing of a child young person or unborn child. In doing so, they can meet their mandatory reporting obligations under the Care Act.

Can you disclose confidential information to the Unit?

You can call the NSW Health Child Wellbeing Unit when you need advice about the safety, wellbeing or welfare of a child, young person or unborn child and their family or when the outcome of completing the NSW Online Mandatory Reporter Guide directs you to do so. All contacts with the NSW Health Child Wellbeing Unit are documented in a state-wide interagency database. Where required, the NSW Health Child Wellbeing Unit can report high risk matters to the Child Protection helpline on your behalf. Notwithstanding this, section 29 of the Care Act 29 provides protection to persons who make reports or provide cetain information.