IMPROVING DECISION-MAKING AT SCHOOL ENTRY MEDICALS - COMPLETING THE AUDIT CYCLE

An audit of decision making at the entry medical was carried out to as certain how doctors responded to childrens' physical, developmental an d psychosocial adversity. Using specifically designed recording protoc ols, eleven doctors recorded their activity at 922 entry medicals over one term. The results were discussed, protocols of decision making we re prepared and ten doctors re-ran the exercise assessing a further 78 3 over one term, one year later. The proportions discussed with headte achers, referred to agencies and selected for review varied in both da ta sets, and certain trends emerged. More experienced doctors were mor e likely to discuss vulnerabilities and did so for 18 to 25% of entran ts in addition to the 20-30% referred or selected for review. The intr oduction of guidelines increased the overall proportion of children di scussed with teachers and reduced, in part, the proportion scheduled f or review. This study informs the debate about selective entry medical s. The findings will be of interest to commissioners of health care wh o have the responsibility for contracting for school entry assessments .