Appleton Jane V
School of Health and Social Care, Oxford Brookes University, Oxford, England.
Prim Health Care Res Dev. 2012 Jan;13(1):60-71. doi: 10.1017/S1463423611000375. Epub 2011 Sep 1.
This study set out to examine how Primary Care Organisations (PCOs) in England manage, organise and deliver their safeguarding children responsibilities.
In the light of changing organisational configurations across primary care, a wealth of policy directives and a climate of extensive media attention around child protection, this paper focuses on how PCOs respond to national policy and deliver safeguarding children services.
This study, based in England, United Kingdom (UK), used a telephone survey method incorporating semi-structured qualitative interviews with Designated Child Protection Nurses. A maximum variation sampling strategy was used to identify two to three PCOs within each of the original 28 Strategic Health Authority sites. From the 64 PCOs approached, 60 Designated Nurses or their representatives agreed to participate in the research, with a response rate of 94%. Data analysis was informed primarily by Lincoln and Guba's (1985) three stages of a) unitising, b) categorising and c) pattern search.
The findings outline how and to what extent PCOs respond to the national policy and organise and deliver their child protection services. The paper highlights some of the key challenges facing PCOs, in particular, safeguarding moving off the primary care agenda, child protection staff recruitment difficulties, a proliferation and overload of policy, resource implications for additional staff training, challenges to collaborative working, high referral thresholds to social care services and cutbacks in public health nursing services. This paper concludes by offering some suggestions about how child protection services could be improved as primary care faces another major reorganisation with the demise of Primary Care Trusts in April 2013.
本研究旨在探讨英格兰的初级保健组织（PCOs）如何管理、组织并履行其保护儿童的职责。
鉴于初级保健领域不断变化的组织架构、大量的政策指令以及围绕儿童保护的广泛媒体关注氛围，本文聚焦于PCOs如何响应国家政策并提供儿童保护服务。
本研究位于英国英格兰，采用电话调查法，对指定儿童保护护士进行半结构化定性访谈。采用最大差异抽样策略，在最初的28个战略健康管理局辖区内各确定两到三个PCOs。在联系的64个PCOs中，60名指定护士或其代表同意参与研究，回复率为94%。数据分析主要依据林肯和古巴（1985年）提出的三个阶段，即a）单元化、b）分类和c）模式搜索。
研究结果概述了PCOs如何以及在何种程度上响应国家政策，组织并提供其儿童保护服务。本文强调了PCOs面临的一些关键挑战，特别是保护儿童工作从初级保健议程中脱离、儿童保护工作人员招聘困难、政策的激增和过载、额外工作人员培训的资源问题、合作工作的挑战、社会护理服务的高转诊门槛以及公共卫生护理服务的削减。本文最后就随着初级保健信托基金于2013年4月消亡，初级保健面临另一重大重组时如何改善儿童保护服务提出了一些建议。
