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The role of the GP in maximising school attendance

Rowena Christmas is Chair of the Royal College of General Practitioners in Wales and a partner at a practice in Monmouthshire. She has a special interest in safeguarding. She is on Twitter: @ChristmasRowena

School is integral to the long-term wellbeing and aspirations of children, so it is a cause for significant concern that school absence has increased markedly since the COVID-19 pandemic.1 It is especially troubling that children from deprived backgrounds are most likely to be persistently absent.2

The Royal College of General Practitioners (RCGP) is part of the Education Secretary’s Attendance Action Alliance in England, where national sector leads from education, social care and health, alongside parent and child representatives, are working together to tackle the underlying causes of school absence.

“Education is arguably the single most important factor in reducing trans-generational inequalities … poor school attendance can negatively impact a child’s future … “

Education is arguably the single most important factor in reducing trans-generational inequalities,3 and poor school attendance can negatively impact a child’s future both socially and developmentally as well as through reduced educational achievement.4

A paper titled, ‘GP Role in Maximising School Attendance – Addressing the Growing Problem of “Ghost Children”‘, was brought for discussion to this June’s RCGP UK Council (RCGP UK Council, personal communication, 2023). The subsequent vote strongly endorsed the call for RCGP to raise awareness among GPs about their vital role in promoting school attendance.

GPs have close and trusted relationships with children and their families, who will often turn to their doctor first when they have concerns. GPs can use this opportunity to reinforce the health and wellbeing benefits gained from good school attendance.

The paper acknowledged that GPs will not be the only group addressing this, but early support to emphasise the importance of school attendance can be key to enabling parents to make the best decision for their children.

Every child has the right to a good education. We want our children to thrive, and to be healthy and happy. For this to happen the majority of young people need to be attending school, seeing their friends, and learning in the classroom.3 Most children in England agree with this assessment. The Children’s Commissioner for England’s ‘Big Ask’ survey from March 2022 gathered over 550 000 responses from children and demonstrated during the pandemic how much they had missed face-to-face teaching, spending time with their friends, and the extra-curricular activities that brought joy and excitement to their lives.1

The benefits of school are many. It offers positive adult role models and gives children a strong foundation for their interactions in society.4 School helps young people build confidence, which is crucial to healthy self-esteem.5 It encourages independent critical thinking and self-expression. These skills translate to every area of life, whether it is in academia, the workplace, or relationships. School widens a child’s horizons and influences their aspirations. Schools are more than just classrooms, they are communities.

“… there is an increasing number of children in the UK who have fallen through gaps in the education system.”

Despite the demonstrable importance of school for children’s development, there is an increasing number of children in the UK who have fallen through gaps in the education system and struggle to attend school regularly. The latest figures show that more than 125 000 children were missing more school days than they attended for the first term of this academic year. This is double the number before the pandemic (RCGP UK Council, personal communication, 2023).

Pupils eligible for free school meals are over twice as likely to have persistent absence,4 while those with an Education, Health, and Care Plan or a Statement of Special Educational Needs are three times as likely.6 There are many disadvantaged children in the UK. The National Youth Agency says that in the UK there are 1 million young people from vulnerable families, and many more with hidden or unforeseen consequences from the pandemic and the cost-of-living crisis.7

In addition to learning loss, a systematic review prepared for Scientific Advisory Group for Emergencies found evidence that the impact of school closures on mental health and wellbeing was substantial and consistent across the range of emotional, behavioural, and restlessness/inattention problems.8

The paper acknowledged there are many systemic issues that are not the role of primary care. Discussion with patient representatives highlighted the need for schools to find a way to engage young people in education who are neurotypical and physically healthy, but not traditionally academic. There is also a need for children and young people with physical disabilities, mental health issues, or who are neurodiverse to have more support to access school, and a trauma-informed approach is often valuable.

The reasons for absence are complex; for some the pandemic has led to disengagement, others are waiting for a Special Educational Needs and Disabilities assessment, and for some it is lack of appropriate provision. There may be a particular medical complaint that affects attendance while the child is ill, and reintegration back into the school environment may need support. Long waits for Child and Adolescent Mental Health Services input can exacerbate attendance problems for children with poor mental health.

“GPs may feel that their focus is their patients’ health, not their education. But this issue is also about safeguarding and addressing societal inequalities.”

Despite this, there are examples of excellent practice, such as the Single Point of Access Children’s Emotional Wellbeing Panel in Aneurin Bevan University Health Board in Wales. Here, acceleration of the referral process to mental health support services has led to shorter waiting times.

Other children are affected by caring responsibilities or financial difficulties that make attending school hard.5 School refusal is challenging for families to manage, and some opt to take the path of least resistance, asking the GP to support their child’s reluctance to attend school.9

Persistent absence grew during the pandemic due to increased illness. On their return to the classroom in autumn 2020, pupils were on average around 1.8 months behind in reading and 3.7 months behind in maths compared to similar pupils in 2019/2020.10 The evidence suggests that the higher the percentage of sessions missed, the lower the level of attainment at the end of the key stage. Disadvantaged pupils have been more adversely affected than their peers by time out of the classroom, falling 0.5–1 month further behind than other pupils.10

Vulnerable children were more likely to be absent in England: 33.6% of pupils receiving free school meals (FSM) were persistently absent in autumn 2021, compared to 20% of pupils not in receipt of FSM.1 While looked after children are statistically less likely to miss school, children living in care homes are a particularly vulnerable group.11 They may have experienced abuse, neglect, and trauma. Moving between care placements or in and out of care will often impact on their school attendance. Children in care are also more likely to go missing. Children missing education can be a precursor to a range of safeguarding issues including neglect, sexual abuse, and child sexual and criminal exploitation, including involvement with county lines where children are groomed and manipulated to act as runners transporting drugs and cash across the country.12

In 2021, the National Crime Agency reported that over 2000 county lines were active across the UK and 90% of English police forces had seen county lines activity in their area.13 The Home Office reported that 27 000 young people were known to be involved in county lines, while 450 000 are exposed to risks associated with gangs.14

“For many vulnerable children, school is a place of sanctuary, a place to escape from dysfunctional homes or violent streets.”

When a child is missing from care, their increased emotional, behavioural, and mental health needs place them at increased risk of being groomed or exploited by people offering them the attention, affection, or support that they have struggled to find elsewhere. Being in school offers them some protection against this. Evidence also suggests that children with a positive attitude to school are less likely to become involved with recreational drug-taking activities.7

The Children’s Commissioner for England has issued a report showing that children attending the first week of school is a strong indicator that a child will go on to attend regularly throughout the term.1 Children who had an unauthorised absence on any day in the first week of term experienced an overall unauthorised absence rate of 25% compared to 2% for pupils who attend.1 If GPs are aware of the importance of that first week, they may be able to support anxious children to attend during this key period.

Home schooling is not an inherent safeguarding risk; when done well it can be excellent. It cannot be ignored, however, that vulnerable children who are home schooled are hidden from view and miss protective factors such as regular contact with their teachers or access to free school meals. Any safeguarding concern is less likely to be recognised.

Patient representative groups highlighted the role of social media in discouraging school attendance for children with neurodiversity issues and described pressure being placed on parents to home school.1 The family may then find this challenging, but by then it may be a hard decision to reverse. Supporting these families with help and resources to enable their child to stay at school may lead to better outcomes.

“Education is crucial for individual children but also for the future of our country.”

Historically, children not attending school for a prolonged period have been viewed from a medical model perspective, which locates the problem as being ‘within the child’. This perspective limits consideration of the environmental factors playing a role in contributing to the absence. It is important to have a holistic view of the child’s needs, considering family, social, and school factors as well as the child themselves.

Each case is different and complex, and the school multidisciplinary team, including the educational psychologist, is better placed than the child’s GP to gain a broader perspective of extended school non-attendance and then to offer support at both individual and family level.15

For many vulnerable children, school is a place of sanctuary, a place to escape from dysfunctional homes or violent streets. These missing children are not spending their days in bedrooms full of books with parents who are supporting their schoolwork. Many turn to gangs for their physical, financial, and emotional needs.7

GPs may feel that their focus is their patients’ health, not their education. But this issue is also about safeguarding and addressing societal inequalities. It will become a national disaster if it is not turned around. Trusted family practitioners have a role to play doing what they do best — practicing curiously, asking the right questions, and supporting parents to make the best decision for their child. Education is crucial for individual children but also for the future of our country.

RCGP Council approved the following five principles:
1. Be alert to when it is better to encourage a child to attend school rather than take time off. Consistently promote school attendance, emphasising the importance of attendance for every child’s long-term outcome, while continuing to support the child and their family.
2. Reassure and have sensitive conversations with pupils and parents about anxiety, particularly at the start of new school terms, recognising the importance of minimising time missed during the first week of school.
3. Remind ourselves that some schools have mental health support teams, and most have a range of self-help resources and organisations to which we can signpost.
4. Encourage parents and carers to speak to school staff about any worries their child may have, enabling them to work together to support their child and improve attendance.
5. Make it practice policy to try and schedule routine appointments to minimise time taken off school. Although broader in scope than just GP appointments, in 2020/2021 there were 4.6 million school sessions interrupted due to medical appointments.

References
1. Children’s Commissioner. Back into school: new insights into school absence. Evidence from the three multi-academy trusts. 2022. https://assets.childrenscommissioner.gov.uk/wpuploads/2022/07/cc-new-insights-into-school-absence.pdf (accessed 5 Jul 2023).
2. Department for Education. School attendance: guide for schools. 2022. https://www.gov.uk/government/publications/school-attendance (accessed 5 Jul 2023).
3. Department for Education. The link between absence and attainment at KS2 and KS4. 2022. https://explore-education-statistics.service.gov.uk/find-statistics/the-link-between-absence-and-attainment-at-ks2-and-ks4 (accessed 5 Jul 2023).
4. Department for Education. Pupil absence in schools in England: autumn 2018 and spring 2019. 2019.
https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/837687/Pupil_absence_autumn_18_to_spring_19_text.pdf (accessed 5 Jul 2023).
5. Berg I. Absence from school and mental health. Br J Psychiatry 1992; 161: 154–166.
6. The Centre for Social Justice. Lost but not forgotten: the reality of severe absence in schools post-lockdown. 2022. https://www.centreforsocialjustice.org.uk/wp-content/uploads/2022/01/CSJ-Lost_but_not_forgotten-2.pdf (accessed 20 Jul 2023).
7. National Youth Agency. Between the lines. 2021. https://static.nya.org.uk/static/f3fcc0c77f1f2d3b579af6274648540b/Between-the-lines-final-version.pdf (accessed 5 Jul 2023).
8. Department for Education. Evidence summary: COVID-19 — children, young people and education settings. 2021. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/963639/DfE_Evidence_summary_COVID-19_-_children__young_people_and_education_settings.pdf (accessed 5 Jul 2023).
9. Pellegrini DW. School non-attendance: definitions, meanings, responses, interventions. Educational Psychology in Practice 2007; 23(1): 63–77.
10. Education Policy Institute. EPI research for the Department for Education on pupil learning loss. 2021. https://epi.org.uk/publications-and-research/department-for-education-publishes-new-epi-research-on-pupil-learning-loss (accessed 20 Jul 2023).
11. Office for National Statistics. Outcomes for children in need, including children looked after by local authorities in England. 2023. https://explore-education-statistics.service.gov.uk/find-statistics/outcomes-for-children-in-need-including-children-looked-after-by-local-authorities-in-england (accessed 20 Jul 2023).
12. Devon County Council. Preventing exploitation toolkit. https://www.preventingexploitationtoolkit.org.uk (accessed 5 Jul 2023).
13. Havard T. Serious young violence: county lines drug dealing and the Government response. 2022. https://researchbriefings.files.parliament.uk/documents/CBP-9264/CBP-9264.pdf (accessed 20 Jul 2023).
14. Public Health England. County Lines exploitation: applying All Our Health. 2021. https://www.gov.uk/government/publications/county-lines-exploitation-applying-all-our-health/county-lines-exploitation-applying-all-our-health (accessed 20 Jul 2023).
15. Checkland P. Systems thinking, systems practice: includes a 30-year retrospective. Chichester: John Wiley & Sons, 1999.

Featured photo by Kimberly Farmer on Unsplash.

21 Comments
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Lors
Lors
8 months ago

This article lacks balance and does not look at how it is very often not school refusal, but a lack of environmental support that creates an environment that a neurodiverse child cannot tolerate as much as they may want to. Parents have very often been fighting long and hard to keep their child in education when the correct settings are not available and having a Doctor insert themselves into the middle of this is unhelpful at best and damaging at worst. Many parents will start to question if going to see a doctor with their child’s ills is worthwhile considering the pressure they will be put under with regards to their child’s education. The medical and educational world needs to start looking at how the system is failing our children, not how we can force a traumatised child back into that same institution.

ATay
ATay
8 months ago

If we hadn’t had GP support we would have been fined. My child was not well enough to attend school. Full stop.

This article sets campaign work back years. It’s going to make it even harder for those living through this hell. It’s even attacking the online support groups. No, they are not encouraging non-attendance. So much misinformation I don’t know where to start.

Unfortunately the truth is that schools have neither knowledge nor the inclination to properly support neurodivergent children. Especially those struggling with the school environment.

My children were failed by school. Being pushed to attend damaged their mental health further. School was actively causing them harm.

Our GP was the only one to listen. The school certainly didn’t. I suggest you research the issue by listening to those with lived experience, rather than continue to spin the line that “school is best”.

It definitely isn’t for most neurodivergent children and barely adequate for neurotypical ones.

Dr Naomi Fisher’s work is a great starting point.

Sharon Antley
Sharon Antley
8 months ago

The writer seems to have missed the fact that school environment is often the actual cause of anxiety/trauma. Schools do not have the resources to appoint every child struggling with mental health (with or without SEN) with an Educational Psychologist. I agree Ed Psychologist are best to get to the bottom of the root issue but these are like gold dust and even LA’s up and down the country don’t have enough EP’s for the demand when assessing for EHCP. This article doesn’t address the fact that schools often ask for proof of medical evidence which can often only be sought via GP as the mental health services have huge waiting lists and waiting lists for neurodivergence assessments are astronomical too. Without evidence many parents are being faced with prosecution when their child is in crisis so have to protect themselves getting medical evidence from anyone that their child has seen medically. If that means GP then that should be available. There is no data on how many children go onto full blown crisis, taking an attempt on their lives from parents feeling forced into sending their mentally poorly child into school when they are just not well enough to cope with life let alone school. Very biased unfounded article.

Nicole
Nicole
8 months ago

The GP’s this rallying call is being issued to have usually barely spent ten minutes with the child whose life is being turned upside down by mental health challenges/neurodiversity/fear surrounding school attendance so are hardly in a position to make the judgement that their daily panic attacks, meltdowns, threats of self harm, contemplation of suicide, burnouts should be overlooked in favour of the many “benefits” of school. Even teachers are being signed off or quitting over the conditions in schools, teachers are opting to home educate rather than putting their kids into that environment. Those speaking to doctors on behalf of their children are NOT seeking the path of least resistance, to dismiss the mental health of such a huge number of children is disgraceful and to call GP’s to ignore their needs is downright discriminatory. Those who spend 40 minutes on hold each day in the hope of speaking to a doctor (any doctor) is not the act of parents who don’t want to try anymore, it is act of parents deeply concerned for the welfare of their child. It is NOT a GP’s role to push school attendance, it IS to listen to their patients/patients guardians, to judge each case on its own merit and to respect that they are NOT psychiatrists and getting it wrong based on a 10 minute conversation and telling parents to keep forcing their child no matter how bad their physical and mental health is could have devastating consequences down the line. Stop scapegoating parents and start recognising that change is NECESSARY!

E J
E J
8 months ago

Seriously? Attending school does not work for all children, it broke my child. And if we’d had the relevant support from those who realy knew about autism and the sensory impact of being in a busy environment we could have avoided burnout. They are doing so much better on EOTAS, but it will be years before the damage school has done will be undone

Stephanie Wozencroft
Stephanie Wozencroft
8 months ago

Parents are seeking support from the GP because schools regularly go against DFE guidance regarding authorising absences for mental health needs. This leaves parents exposed to threats of courts, fines and imprisonment. A note from the GP is usually requested by schools to grant specialised provision or authorise absences, despite this again, being against DFE guidance. Stop blaming the parents and take a good hard look at how the institution is failing children.

Jo Griffiths
Jo Griffiths
8 months ago

This beggars belief and just shows the ignorance towards those neurodiverse children who are not refusing but rather unable to attend. Having insulting comments like “and some [parents] opt to take the path of least resistance, asking the GP to support their child’s reluctance to attend school’ screams a complete lack of understanding. Please don’t insult parents and children to whom school is most certainly not ‘a sanctuary’, but a place of trauma. Parents of neurodiverse children are begging for specialist support that falls on deaf ears or at the very best, comes way too late or is woefully underfunded and a poor match for what is actually needed.

Justme
Justme
8 months ago

I’m not sure for everyone things are this simple.

For some schools are not safe places. They are places where they are in fear harmed physically and psycologically by their peers with staff who refuse to help.

They can be overwhelming with different smells and constant background noise challenging sensory issues such as blazers or shirts scratching too hot or too cold

Teachers don’t understand abd don’t offer the support to aid effective communication and interaction with peers can feel confusing and complex.

The rules are too rigid to facilitate those who just can’t sit still or who need to take 5 min.

For these children school can be living hell

These children have no accessbto educational psycologists no access to mental health with waiting lists lasting years ehcps take constant battles and are not complied with.

For many they may fight to attend just to sit in lessons not suited to their aptitude and ability achieving nothing but a tick in a register. Damaging their confidence and self esteem even mire than the frustration of feeling exhausted just from managing everything else.

For some children they need a gp to advocate for their needs to support them to access the support they need not dismiss their anxiety to enforce attendance statistics.

They system isn’t working the attendance rhetoric is not in every child’s best interests.

Where school is causing harm the role of a gp should be to advocate for their patient not go for the route of least resistance blaming the parents desperate to help their child with no support from anywhere.

Jane Anderson
Jane Anderson
8 months ago

This article is unfortunately completely missing the point that “attainment” and “success” are not things achieved by a child who’s needs are not met or understood in the current system and it’s not the children or parents that need to change, it’s the system, it needs to be completely overhauled and an actual understanding of the issues needs to happen

JJ
JJ
8 months ago

This is a sad read. I had so many meetings with school to try and make adjustments for my child. They were not interested. I want a doctor who looks at my child and considers their unique perspective, not to have to take a mandatory response. I feel sad that everyone seems to want to push attendance as opposed to perhaps we need to change the system. My child wanted to be in school and I wanted them to be in school. Our decisions were not taken lightly. 8 months of trying to enable my child to attend. If I felt my GP would take this approach, I would feel less likely to go, isolating me and my child further.

MrsG
MrsG
8 months ago

I have had enough of this rhetoric, the parent blaming and ignorance of just how hard it is to just see your child in this state of hopelessness and despair each day, much less the fight to get them support that meets their needs!

“GPs have close and trusted relationships with children and their families,”
Does anybody actually see their own GP anymore, coz where I am you can’t get into your SURGERY much less with your own doctor!

“the impact of school closures on mental health and wellbeing was substantial and consistent across the range of emotional, behavioural, and restlessness/inattention problems.”
And this was not magically fixed when they reopened yet nothing has been done within the school system to address it – all the government has done is add pressure to catch up.

“wellbeing benefits gained from good school attendance.”
Yes well milk has wellbeing benefits too, unless you’re allergic to dairy. If school attendance is what is causing distress to an individual then school attendance loses its wellbeing benefits to that individual.

“It encourages independent critical thinking and self-expression.”
No it doesn’t, it tells you how to think, what to wear and what colour you can wear your hair!

“some opt to take the path of least resistance, asking the GP to support their child’s reluctance to attend school.”
Has anyone here EVER asked their GP to support their child’s reluctance to attend, or have we recognised a mental health need for support and decreased pressure? Because that isn’t the same thing at all. And I have three kids at two different schools, two of whom are awaiting assessment for neurodivergence, plus one more who is now home educated due to severe anxiety and having to attend various appointments with mental health services who AGREED the pressure of school was too much for her mental wellbeing and that we were right to remove her (only weeks after our GP refused to sign a sick note without so much as having spoken to her). If I were taking the path of least resistance I would just have all of them at home but they each had different needs, including going to school for the social experience, and I meet every single individual one where it is within my power to do so, so do not dismiss me and parents just like me with such an appalling (and incorrect) generalisation!

“In 2021, the National Crime Agency reported that over 2000 county lines were active across the UK”
And guess where they recruit the kids?! This may be relevant to children who are absent because of truancy and are hanging around the neighbourhood, but not to the children whose GP’s play any role in this due to genuine mental health requirement. My daughter won’t even leave the house without a trusted adult, as is the case for many of the children whose parents are in this situation, they are hardly the opportune targets for County lines activity, “Oh excuse me Mrs XXXXX, would you mind if we have a moment with your daughter?” Isn’t, I presume, their usual recruitment technique!

GP’s need to recognise their expertise does not lie in mental health and rather than pushing a child with psychiatric or neurodevelopmental challenges into school despite the resulting daily trauma, defer to actual specialists in the fields who recognise the seriousness of the mental health conditions this can cause further down the line.

Marie
Marie
8 months ago

Oh my goodness – there are so many gaping holes in the arguments in this article, you’d be hard pushed to catch a fish with it!
Let’s start with the glaringly obvious – the presumption that school itself is a wonderful institution that holds every child in it’s warm embrace, whilst fulfilling their every social and academic need. For 100,000s of children school is not a safe, welcoming, supportive nor educational space – it’s entirely the opposite, and the first thing we should be looking at when investigating school absence is why so many children can’t access school, and why so many fail academically. Could it possibly be that school is not safe, and doesn’t effectively facilitate learning? As you’ve so well stated in the article, the state is a terrible parent, could it also be a woefully inadequate educator too?

Mandi Childs
Mandi Childs
8 months ago

Perhaps instead of gp’s telling parents of the benefits of school, they can listen to the parents explaining why school isn’t a safe place for the child, and then help the parent to advocate for the child. School isn’t always the best place, and is sometimes damaging. For a child to learn, they have to feel safe, or they are just in survival.

When talking about school offering positive adult role models, does that include where my child was kept in at break times because he didn’t do his written work, despite me telling them I was querying dyspraxia. Does that include the teacher who physically took my child’s top off, even when my child held his arms down. Or how about when my child was pulled from me, when he was in tears, just to keep him in school even when he wasn’t engaging. Does this sound like an environment where a child can feel safe enough to learn, or accept the adults as good role models.

Staff are not properly trained in understanding and supporting sen, even my child’s senco didn’t know how to record his attendance, until the education welfare officer corrected them.

Parents of neurodivergent children are doing a balancing act, of trying to support their child getting an Education, while also protecting their childs mental health. A suicidal child is not better off at school, when the school is the root cause of the suicidal thoughts.

Parent blame is at the centre of all of this, along with pressure on the children without much support. I wonder if in writing this article, any parents in this exact situation were consulted for a balanced article. I think not from the content of the article, and from the streams of comments rebutting the article.

Vicky Hunter
Vicky Hunter
8 months ago

With budget cuts and reductions in TA’s, a lack of appropriate SEND training and increasing pressure on teachers to focus on results, it’s no wonder, the country are in this position. Schools aren’t always nurturing, positive, environments with great role models. The staff are stretched and simply don’t have time or resources for those needing it most.

Using GP’s to encourage pupils into school won’t simply solve the problem! How ridiculous.

Kirsten Crossman
Kirsten Crossman
8 months ago

Whilst this article has some elements of understanding it has huge gaping chasm s of misunderstanding alongside. The vast majority of Parents of Children who are ND or who have a SEN & or a mental health issue want their Children to attend School. The majority of Children also want to too. However a mainstream School Environment whose Teachers have little to no training in SEN is not therapeutic .There is currently no mandatory training for Autism or other ND or SEN. SENCO’s do not have to do training in post for several years yet many assume they are experts. Rigid School rules & unrealistic expectations for Children who are ND to simply conform leads to burnout or mental health breakdown. Educational Psychologists are very few & far between & waiting lists are long.Most Schools refuse to pay for assessments unless they are part of an EHCP. The LEA often refuse to assess or grant an EHCP initially even though the threshold for assessment is low. Breaking Government guidance & their statutory responsibilities on a frequent basis. The wait for assessments & an EHCP is often long. Many Councils failing in fulfilling the legal time frame. The waiting list for CAMHS is often years if accepted at all. For many CAMHS will not even see unless a Child has attempted suicide, self harm or has an eating disorder. Many Children do not feel safe at School contrary to the article. As for allowing independence & critical thinking , most Schools encourage rigid conformity with no flexibility. The opposite, in fact denying many with a ND the chance to think outside of the box or to explore their creativity. The curriculum can be rigid & the focus is more geared towards exams , which do not suit everyone. Until we address the real issues which is no understanding of SEN, no reasonable adjustments for disabilities, large class sizes , lack of funding for education & health & very long waiting lists then we are just causing more issues for Children & Parents.
As for social media & support groups. Many Parents turn to these for support & understanding as there is no understanding of the causes & little will to change the core issues. These are not Parents who don’t care. These are Parents who have tried everything, have asked for help , assessments etc & have hit a brick wall. They then feel they have no choice. Many are threatened with fines or imprisonment whilst trying to desperately get help from systems that have failed. These are not Children who hang around street corners but Children who are so anxious or low they cannot leave the house. These are Children who are punished for coming into School late when they have spent the morning in a highly distressed state having a panic attack , vomiting. When there body is in a heightened state of fight or flight & some Schools response is to punish them. No understanding, no reasonable adjustments, no holistic care just a rigid one size fits all approach.
There is no follow up after diagnosis, no support & no understanding. No wonder the School system is broken. Not enough TA’S to support & too many students in a class to understand individual needs or recognise when a pupil is struggling. Rewards for attendance. For Children with complex health needs they will never reach full attendance. Impossible even without any due to Orthodentic appointments being in School time & Paediatric OPA.
Most of these Parents have spent hours every day trying to support their Children to attend School. Have had to endure Sundays when their Child is in full panic mode, not eating, not sleeping. These are Parents who have read, researched, booked appointments, sought help from Charities when no Educational or health support is forthcoming.
These are Parents who have had numerous meetings with Schools, sent emails, phonecalls. Asked for reasonable adjustments. Asked for their Child to be heard.
My own Children are 2 of these Children. Both have SEN in one form or another. Both have anxiety related to their SEN. Both have had perfect behaviour at School but have had numerous struggles to attend at one point or another due to their SEN & the School environment. Both had low attendance to varying degrees depending on the situation at the time. The environment was often reactive not proactive & this led to them not being able to attend unless small issues were sorted. Change was huge & often not communicated before hand.
They have both now just left School & their mock results were outstanding despite lower attendance. When a Child is severely anxious they may be present at School but little to no learning will be going on. For my Children they were often unable to attend lessons so we’re present but not learning. Sometimes just playing games to build up trust & support. We were lucky in that their School were largely supportive & we had no pressure on attendance just support & trying to find solutions at every step. Sadly many Schools are now run as businesses by Academies whose focus is on attendance at any cost.
SEN Children cannot attend with understanding, support & reasonable adjustments which many do not want to give. OFSTED is at odds with this individualised approach. My Child could not attend for 7 weeks at all in year 10 but the School allowed them to attend School play rehearsals & to source or make many of the costumes. They did not punish them or refer them to the attendance officer. We maintained frequent contact & they were caring & supportive. Many are not!
We could have instead been facing a fine for non attendance.
Many Children are missing School whilst awaiting a non existent place for a SEN School. Yet another battle. No one cares about them. No one cares about the LEA’S hauled before Education Select Committees multiple times for their failures to Children & their SEN provision. No one cares that Parents have had to give up work to support their Child.As it is very difficult to sustain a full-time job whilst trying to support a Child with SEN to attend School.
These are not Parents who have taken ‘ the path of least resistance ‘ far from it.
As for the GP being the person who knows them best what utter tosh!
There is no such thing as a family GP any more. If you are lucky enough to get an appointment then t is rarely with the same Dr. A ten minute appointment is not long enough to understand my Child or anyone else’s. Parents know their Child best & the Child’s views matter too.
It is not hard to understand the issues our Children face in Education. A quick Internet search for the amount of SEN charities, Solicitors, newspaper articles will tell you.
Radio 5 dedicated a whole day to stories from Parents, Teachers, Psychologists, Social workers etc.
Most of them saying that training is key , fines don’t work, underfunding causes significant issues. Nor enough Teachers, TA’S, Ed Psychs, SLT, OT’s, CAMHS etc etc.
Teachers are leaving in droves .The issues are systemic. Yes there are Children who are vulnerable & are targeted, many again let down by our Social Care system.
Parent blame here is not the answer & punishing Children isn’t either.
Simple anxiety isn’t the same as an anxiety disorder. We all get anxious is certain situations but not every day in an environment which we have no escape from.
Every Child wants to learn & not be punished for circumstances beyond their control.
There is so much wrong with this art& new guidance that I could write pages but will leave it there & just urge GP’S to understand & consider the wider issues & each Child as unique with their own issues which cannot ever be solved by a one size fits all approach.

Andrew
Andrew
8 months ago

My ASC/ADHD/PDA daughter has been unable to attend school as a direct result or trauma cased by poorly trained leadership that failed to address her SEND & SEMH needs. She has C-PTSD as a result. This has been confirmed in writing by CAMHS psychiatrist.

It is beyond unlikely that any GP has more knowledge of the young ND brain than a Consultant Adolescent Psychiatrist, so in this example the (comparatively) poorly trained GP’s input could have compounded my daughter’s trauma, and worse still created a serious lifelong problem by causing her to distrust doctors.

The level of understanding of ASC/ADHD/PDA etc. within most GPs is considerably lower than that of many of the parents of their child patients, so for all their medical training they are not fit to dictate. And by trying to they traumatise vulnerable young people, who may never trust the medical profession as a result.

And that’s far more serious than missing a year of two of school, to catch up later. Although the state doesn’t like that, because it costs more.

My recommendation is that Pathological Demand Avoidance (PDA) become a diagnosable condition in DSM.5 / ICD.11 and that any child with school attendance difficulties be tested for it before they are subjected to further trauma.

And there should be an SLA of days on that test, not years as CAMHS would otherwise have it.

GP’s should by now know better following the mandatory Oliver McGowan training, but it seems the author of this article somehow missed that vital day. As such I don’t feel they are qualified to comment.

All staff in schools should also be forced to attend the Oliver McGowan training. Something as simple as that could save countless trauma, self-harm, and even suicides amongst young people unable to cope with the increasingly authoritarian environment that is forced upon them.

Tracy Bingham
Tracy Bingham
8 months ago

Little consideration of the impacts of SEND on families or child. The lack of appropriate childcare for SEND children especially those with ASD means, parent with prosperous careers are forced out of the workforce. No mention of forced and illegal part time timetables, forced flexi schooling or the increase of FII accusations and parental blame for schools lack of knowledge or unwillingness to meet needs. No come back in schools for failing to meet even basic needs or even those required in EHCP. Daily I watch educational staff physically peel children’s hands off parents as they scream not to go in. Parents manhandling their children through the school gates. Yet this school is outstanding as attendance is deemed good, because if parents dont force them in they are quick to fine and refer to social services. If children were screaming not to come home concerns would be raised. But if the child has Autism or other needs the school doesn’t want to deal with, working parents are daily asked to collect their dysregulated child with EHCP at 12:01pm just after registers close so attendance looks good, whilst not fulfilling anything in EHCP. Schools choose in some cases to not even gain basic knowledge of things like Autism, so staff are conpletely unable to implement any appropriate strategies or even empathise. Schools are failing, the system is failing. The schools are no longer inclusive, they are focussed on stats that Ofsted are interested in, not SEND children.

A concerned parent.
A concerned parent.
8 months ago

As parents who spent 9 years supporting, encouraging, and working with each school to enable our child’s attendance, (and as a social care professional) I find this article damaging and misleading. Not to mention dismissive and disrespectful to the thousands of parents who are experiencing barriers to school attendance.

If a child refused to come home when school finished, there would be safeguarding concerns raised, followed by reports and investigations with children’s services. However, if a child experiences the same feelings about going to school, the same chain of events does not happen. And now this article suggests that if a parent reaches out to a GP for their professional opinion to signpost support or diagnose a possible underlying mental health condition or neurodivergence then the GP should just tell them that ‘school is important’ and ‘the child should go to school’?

How far do our children have to be pushed before they break? In our case it was 9 years, when we realised the school system was forcing our child to mask their neurodiversities so they fitted into the school system. Devastatingly, the years of the burden of this caused them incredible anguish, and burn out, which manifested as anxiety, emotional withdrawal and self harm, and then active suicide ideation.

Yes, learning is incredibly important, but this does not always have to happen inside a building, between certain hours, on certain days, of certain weeks, of certain years, of someone’s life, and it most certainly shouldn’t be at the detrimental of a person’s mental or physical health.

GPs, please support your families, not turn them away. Do what you do best and help diagnose and treat the medical cause for the child being unable to engage with this important part of their life. You are not part of the education system, treat your patients as patients.

Amy Stokes-Cooper
Amy Stokes-Cooper
8 months ago

This might not work as an analogy but…
When my first child was born, I was definitely going to breastfeed. 💯 I was won over by the midwives’ “encouragement” to do it nature’s way. A friend, who was a breastfeeding, attachment parenting advocate, supported me – almost hourly, at times, it felt – with messages of encouragement to persevere and decline any ‘pressure’ to give formula. It eventually became apparent that although I thought I was breastfeeding well, and my daughter WAS in fact latched on properly (because absolutely any BF-related issue must be down to the latch…)
Eventually, on day 5 I asked for a bottle of formula, because despite my best efforts – and a gruelling regime of waking her 2 hourly, attempting to feed her, seeing the distress when she got nothing, then attention to express with a screaming baby next to me, repeated until I was almost insane – I was told that my baby was severely dehydrated. I was immediately given a bottle, which baby drained within minutes, and we were allowed home! Apparently, they couldn’t suggest formula but if it was my (completely novice new parent!) suggestion, then they had to agree.
She never fed from the breast, despite my best efforts to persevere at home, and continuing with the expressing regime. I lasted 4 weeks before abandoning ‘nature’s best’ way for entirely formula fed.
My point in all of this is that a FED baby is what was needed. It didn’t matter in this situation how I fed her; but one thing is certain: if I had not opened my eyes to another way – formula – she would have died. (Extreme, I know, as presumably the health professionals would have stepped in with “artifical feeding” 😡 before then!)
Roll forward almost 12 years to my beautiful daughter’s first week at secondary school. I could not have “liaised” or communicated with the school more regarding the very difficult background in our family: that her dad – who was still living with us at that point – is a chronically relapsing alcoholic who had been in and out of hospital for the last three years. I didn’t tell them for entertainment’s sake; I told the head of pastoral care, face to face, before my daughter even set foot in their school, so that any potential issues could be pre-empted.
I’m going to miss out the painful details of how they let my daughter down, didn’t do an early help referral until I had been told about it by friends who were astonished it hadn’t been done as soon as I even mentioned the words “father is an alcoholic”, sent me attendance letters despite my daily emails with the head of year and form teacher, but when I said to my GP and the School nurse – one morning where I had literally dragged her out of the car sobbing at the school door and handed her over to her teacher and the “pastoral lead for Yr 7”, being told ‘she’ll be fine’ – “if I turned up for work in the state that she turns up for school, there isn’t a boss in the world who would sit me at my desk, tell me well done for coming in and to just get on with my work: I feel like I want to pull her out of school” the school nurse said “do it” and the GP, who had already met her face to face about her school-related-anxiety, suggested finding another school.
There is absolutely no acknowledgement in this article that a) ‘school’ and ‘education’ are not the same thing and therefore not interchangeable; b) not all schools are safe and nurturing environments; and quite frankly, I’m boring myself now, but c)”positive adult role models”?! Adult role models conditioned to enforce the mistaken, short-sighted beliefs that the previous two statements are true, more like!
One size does not fit all, and increasingly in this world, one size doesn’t fit very many at all.

Nicola Cattrell
Nicola Cattrell
8 months ago

Yet more, let’s.force all the traumatised, neuro diverse kids into the matching meat grinder of school, where there is no.sipport.for children who cannot cope in the bullying, aggressive, competitive environment of getting school grades, whilst being forced to look and act the same. God help you if your outside the box. You will be pushed into it, or fined, broken, re traumatised, so then school ticks the right boxes.

Concerned Parent
Concerned Parent
8 months ago

This article has an interesting title. To the naive, it could suggest that a GP might offer help in supporting a family trying to help a child win a place at a specialist school but whose GP has time for that? In reality, the short answer is that GPs have have no role in “maximising school attendance” as education it is none of their business.

GPs are not trained in education, or, in most cases, in any of the factors that cause barriers to school attendance. They may have some passing acquaintance with child mental health issues but it is unlikely to match that of their patients’ parents or carers, who have probably been living with and supporting them for years, often without help.

Unless the GP has an intimate knowledge of the child’s school environment, presentation before, during and after school, together with training in child psychology, they will be no more qualified to interfere than the milkman. Unfortunately schools will, however, still demand that GPs step in to “validate” parents’ notifications that their children are too unwell to attend school. This is despite the advice given by the Government in its Guidance for Schools published in May 2022 titled “Working together to improve school attendance” in which it stated that

“Schools are advised not to request medical evidence unneccesarily”.

It is interesting to note that this document details the responsibilities of schools and parents and indeed the procedures by which parents can be taken to court to be fined or, ultimately imprisoned, but nowhere does it mention the role of GPs.

I would suggest that the role of GPs is to help their patients. They can do this best by listening to and trusting them and their parents. If they genuinely feel that, having met the teachers and spoken to the child alone, the school is the safe and trusted party, and it is the parents who are doing the harm, then they should follow their safeguarding procedures. Otherwise they should refer their patient to the service best qualified to deliver the service they need and support the parents in any other way they can.

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