GPs' responses to adolescents presenting with psychological difficulties: a conceptual model of fixers, future planners, and collaborators

Abstract

Background: Psychological difficulties are common in adolescents yet are not often addressed by GPs. Anxiety and uncertainty about professional practice, with a reluctance to medicalise distress, have been found among GPs. GP involvement in this clinical area has been shown to be influenced by how GPs respond to the challenges of the clinical consultation, how they view young people and their perception of their health needs, and a GP's knowledge framework.

Aim: To explore the relationship between the above three influences to develop an overarching conceptual model.

Design and setting: Qualitative study based in 18 practices in the north east of England. The practices recruited included rural, urban, and mixed populations of patients predominantly living in socioeconomically disadvantaged communities.

Method: Theoretical sampling was used to guide recruitment of GP participants continuing until theoretical saturation was reached. Data were analysed using the constant comparative method of grounded theory and situational analysis.

Results: In total 19 GPs were recruited: 10 were female, the age range was 29-59 years, with a modal range of 40-49 years. Three levels of analysis were undertaken. This study presents the final stage of analysis. GP 'enactment of role' was found to be the key to explaining the relationship between the three influencing factors. Three role archetypes were supported by the data: 'fixers', 'future planners', and 'collaborators'.

Conclusion: The role of GPs in managing adolescent psychological difficulties is unclear. Policy advocates a direct role but this is unsupported by education and service delivery. GPs adopt their own position along a continuum, resulting in different educational needs. Better preparation for GPs is required with exploration of new, more collaborative models of care for troubled adolescents.

Keywords: GP consultation style; adolescent psychological difficulties; youth mental health.