Today, we’re speaking to Dr Tom Purchase, a GP and Health and Care Research Wales NIHR doctoral fellow.

Title of paper: Co-generating ideas for safer paediatric care in general practice with parents and stakeholders

Available at: https://doi.org/10.3399/BJGP.2025.0690

Research has highlighted the important role parents play in in paediatric patient safety, for example, through mitigating safety incidents in general practice, yet their perspectives have rarely shaped system-level improvements. This study co-generated and prioritised ideas for change with parents and key stakeholders, identifying feasible and impactful strategies to improve paediatric safety in primary care. These strategies centred around practice communication, accessing care records and results, and fostering a culture of shared learning and development. Parents are willing and able to contribute meaningfully to safety improvement efforts, and their insights align with national patient safety priorities. Clinicians and policy makers can use these findings to strengthen collaboration with families, tailor safety interventions to local needs, and embed parent voices into the design of safer care systems.

Transcript

This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions.

Speaker A

00:00:00.480 - 00:00:49.500

Hello and welcome today to BJGP Interviews. I'm Nada Khan and I'm one of the Associate editors of the Journal. Thanks for listening again to this podcast.

In today's episode, we're talking to Dr. Tom Purchase. Tom is a GP and a health and Care Research Wales NIHR Doctoral Fellow.

We're here today to talk about the paper he's just published in the bjgp and the paper is titled Co Generating Ideas for Safer Pediatric Care in General Practice with Parents and Stakeholders.

So, hi, Tom, it's really great to meet you and to talk about your work, but before we talk about the study itself, I'm interested to know what first got you interested in pediatric patient safety in general practice.

Speaker B

00:00:50.060 - 00:02:26.850

Thanks. It's born, I think, out of an extension of the work that we've been doing within the patient safety team within Cardiff University.

So a lot of what we do is looking at incident reports, safety incident reports, and trying to pick out what are the, you know, high level key learning points and takeaway messages from those.

And then within the team, we started to think about, as well as the types of incidents and the types of harms that are occurring within pediatric incidents. For example, how are parents involved?

And it was a bit of a novel approach to what we normally do, trying to have that extra aspect within the incidents and figuring out how parents were either helping to contribute or to mitigate against the incidents, not just looking at the incidents themselves. So that was the starting point, really.

And then once we'd started digging into that data and identifying that, actually the majority of the time, which is in one of the papers that was published last year in BJGP, 77% of the reports we were looking at specifically around general practice showed that parents were taking these mitigatory actions that, you know, positive actions that were able to prevent harm or further harm from occurring to their child, for example, chasing results or chasing referrals or importantly, being able to speak up. And then that highlighted, I think, the importance of parents being able to have a voice and advocating on behalf of their child.

And that really sparked, I think, the interest, and therefore this part of the.

Speaker A

00:02:26.850 - 00:02:46.490

Project, and I think that's a really interesting thing about this paper, is that it focuses on parents and parents not just as observers of care, but as active contributors to safety. And I wonder what your thoughts are about why that's an important shift in how we think about these things.

I think you've touched on it a bit, but yeah, I'm interested to know a bit more about that.

Speaker B

00:02:46.810 - 00:03:55.980

I think it is a really important aspect of care, but also particularly safety, which maybe is untapped in terms of parents as a resource as to how we can keep children safe.

We know that children on the whole are more, maybe not more vulnerable, but certainly are a vulnerable group when it comes to patient care in general and patient safety.

And that's because they're so heavily reliant on others to speak on their behalf, to make sure somebody else is looking out for their healthcare needs. And therefore they are probably playing a part within the world of patient safety.

And there are good studies from hospital relating to incident reports that show that parents are capable of picking up issues early on. They're able to detect issues that maybe other parts or people within the system aren't detecting.

And as I mentioned, our paper from last year specifically looking at general practice showed that parents are able to prevent harms from reaching their children. So they're playing a substantial part already.

And from a systems perspective, that is mainly parents figuring out workarounds within a system that really isn't, I don't think, designed to support them as well as it could be.

Speaker A

00:03:56.460 - 00:04:33.810

And I guess that's kind of the crux of what you were doing here.

So I guess before we get into findings, just, you know, a quick word about the methods because you worked here with groups of parents to develop ideas for improving pediatric patient safety in, in general practice, in primary care, and then you explored those ideas with a wider group of stakeholders and that included clinicians, managers and policymakers, and then brought them all together to co generate ideas for safer care. And it was really interesting because the parents generated 16 different ideas for improving safety.

And were there any that particularly surprised you and jumped out at you?

Speaker B

00:04:34.450 - 00:05:33.980

I don't think necessarily any were too surprising on the basis that we. I don't think I really had any thoughts going into it as to what they might say.

But I guess what did surprise me more was that some of the ideas that we then took forward to the stakeholder group kind of highlighted some disparities or some clear disagreements between the parents who were accessing our services and the people who work within the services. And how we viewed, I suppose, viewed what's actually happening, that kind of work is imagined and how we think things are going and the work is done.

I guess what the parents were trying to do to come up with the idea is to bridge that gap unknowingly. I suppose maybe what's surprising is that none of them, I didn't think any of the ideas were necessarily too resource intensive.

You know, I think what was quite reassuring is that lots of what the parents were saying were actually relatively simple things that we might be able to enact or at least adopt or adapt, you know, to our own environments.

Speaker A

00:05:34.540 - 00:05:47.730

And a lot of the ideas seem to center, I think, around communication, access to records and test results, and actually just helping parents to speak up. And why do you think those themes emerge so strongly?

Speaker B

00:05:48.450 - 00:07:24.990

I think that comes back to maybe that difference between how we like to think the system's functioning and how parents think the system's functioning as healthcare professionals and parents.

Because we know from a thematic analysis we did, which is also going to be published in bjgp, from these discussions we've had with the parents, that a lot of them said they felt the need to fight in order to be heard.

So although within, say, pediatrics and GP training programmes and CBDs and everything we have to do for revalidation, taking ideas, concerns, expectations, collateral histories, making sure we're really considering that the holistic approach is all considered clinically, what you're then getting, I suppose, from the parents is that maybe we're not doing it as well as we could be.

And one parent within the workshop said, I know as a parent you are expected to advocate for your child, but what it surprises me is how regularly you have to do it and sometimes it feels like a full time job.

And I think that one really struck a chord in terms of really emphasizing how much extra effort and how much work parents are feeling they need to put in. And I think that also implies that the system isn't making it as easy as possible for them to be able to do the right thing.

So I can't necessarily explain unfortunately why they feel that those areas needed to be targeted.

I guess it's because there are barriers that we are not tackling correctly in order to help parents to speak up more efficiently and certainly to be listened to.

Speaker A

00:07:26.840 - 00:07:35.160

And one of the stakeholder priorities was this idea of a designated parent advocate. Can you tell us a bit more about that idea and why it resonated?

Speaker B

00:07:35.640 - 00:09:21.810

Yeah, sure.

I really liked that one and I thought it was an interesting one because again, it highlighted, I think, a number of issues that we could discuss in a lot more detail. I know this podcast isn't ours. I think we could talk about it for a long time.

So that one, I think came out of the need that parents were identifying to sometimes just want to clarify something if they weren't quite sure how to access something or they didn't really know how something worked. We know that our systems are complicated and one of the issues we found was parents found that just navigating that system was an issue.

So it's one way of trying to work around that.

If there's someone that you can speak to who understands the system, maybe working within the practice or even as a third party, you know, you could go to them and get some advice. But they also specifically said it's not just kind of system advice, it's also advocacy, help, well being.

If they wanted to give feedback or raise a concern. It's someone who is very importantly separate from that complaints process.

Because I know I keep talking about the system and how it's designed, but the complaints process, for example, is very specific.

And what we found talking to the stakeholders is that they, they felt that what the parents were asking for here kind of already existed, but in the form of maybe the complaint system, which obviously has a particular purpose, isn't always easy to use. You know, if you've got to email the practice manager, that might not be something that you want to do.

And parents worried about coming across as a nuisance or having some negative repercussions on them. So it was an idea of here is someone who's maybe a bit more independent, they know how things work.

I'll be able to get some sound advice from them and that might be able to help me progress or to get my voice heard in a way that wouldn't have a negative repercussion on me.

Speaker A

00:09:21.890 - 00:09:38.050

And I think a lot of GPS listening will be thinking about what this work might mean for their own practice. And which of the proposed changes do you think are most achievable at practice level?

Is it that about a parent advocate or are there any other ideas that you thought could be achievable?

Speaker B

00:09:40.360 - 00:11:56.550

Thankfully, that was one of the questions that we were asking the stakeholders.

So when we took all of these, the 16 ideas to the stakeholders you mentioned, we specifically said of these ones, which do you think are the most doable and which ones will be the most impactful?

And then we went through each one in turn and plotted them on a matrix to say, you know, to try and come up with an arbitrary way of saying, well, which ones do we think are the most impactful and most doable that we could then suggest to, as you say, practices or readers in a meaningful way.

Where there was most agreement between the parents and the stakeholders, as well as being positioned as the most doable and the most impactful, was asking parents for solutions and feedback.

So parents felt that they weren't being asked enough for their opinions and their experiences when it comes to, well, lots of parts of the process, but obviously in relation to safety.

And then the stakeholders also strongly agreed that actually, if we're going to improve our way of working and integrate the parent voice more, we obviously need to be asking them.

And in lots of other industries, we're obviously asking for feedback all the time, and we don't necessarily do it very well in the NHS or within general practice specifically. So I think it reflects maybe, you know, a broader issue about patient and public involvement that in.

Specifically in the context of parents, because child safety is so important to them, I think their involvement is therefore seen as a really important role that maybe they're not currently being given the opportunity to fulfill the disagreement or not disagreement. But the discussions that happened in the stakeholder meeting around this, everyone agreed that it was a good idea, but it was.

How it was then implemented was maybe going to be obviously based on where you are and your population, but also what you were actually asking the parents for.

So whether it's a case of doing something similar to us, where you maybe have a focus group or workshop, or whether you just send out a survey with some specific questions, or if you speak to some individuals with one stakeholder, highlighting that if you do have a significant event or some safety incidents that you've been looking at, are you then talking to the people who've been involved, those parents, and trying to identify the gems that sometimes come out of that in order to identify where you can make improvements that could lead to a meaningful change?

Speaker A

00:11:57.330 - 00:12:08.290

Yeah, I like that idea of involving parents in significant event meetings, or at least taking the results of those two parents, because often I feel like those meetings are kind of closed within the practice, aren't they? They're not.

Speaker B

00:12:08.770 - 00:12:30.960

Yeah, absolutely. And there's no reason necessarily that we couldn't. I think it's just maybe we haven't thought about whether we could or we should.

And then once you start to have those ideas, you know, you can then start thinking about, well, how feasible is it? How could I manage this?

Or even quality improvement projects or any kind of safety activities, you know, probably could have parent involvement as well. We're just not necessarily thinking about it in those terms.

Speaker A

00:12:31.440 - 00:12:39.440

One thing I thought was really interesting is that the paper talks about parents as a source of resilience within the healthcare system. What did you mean by that?

Speaker B

00:12:39.920 - 00:14:07.020

So what we mean by system resilience normally is how adaptable is that system to any change or unpredictability which within all of healthcare, being the complex socio technical system that it is, we are constantly facing unpredictable scenarios.

And you know, those, those interactions between us, the parents, the children, all the other staff, our technologies are always changing, the organizational structures are always changing. You never quite know how the interactions between all those elements are going to come to fruition or what's going to emerge as a result.

So resilience is facing all of those changes.

If something was to happen, how well can you know you bounce back as a practice or how well are you going to be able to cope with an issue or an event? And parents being an important part of that system.

Resilience is because not just as a safety net, but also as an information source and somewhere to go or someone to talk to who would be able to, as we mentioned earlier, pick up on when something isn't quite going right, or if they want to challenge a decision.

And from a human factors and ergonomics point of view, we know that when someone is able to advocate or speak up or challenge or help to correct something that supports resilience. So it's giving the systems all of the opportunities to continue to function safely and correctly that it can.

Speaker A

00:14:07.180 - 00:14:15.340

And I guess having done this work, what do you think is the one thing you'd most like gps to take away about working with parents to improve safety?

Speaker B

00:14:15.730 - 00:15:03.200

If I had to choose one, I think it would be encouraging parents to speak up.

Lots of things we've talked about obviously in this podcast around how we could incorporate them in other ways, but just the simplicity of validating their concerns and considering their concerns as clinically meaningful.

But then creating a culture within the practice where a parent speaking up or asking a question isn't viewed as a criticism, which I think is often the case, or a hindrance and welcoming and proactively seeking out parents insights.

So trying to shift the thought process from parents being passive participants within our system to actively trying to incorporate their voices into what we're doing on a daily basis.

Speaker A

00:15:03.520 - 00:15:15.510

And I'm going to ask sort of a similar question but in a slightly different way. But if you could implement just one of the ideas from the workshop in your own practice, which one would it be do you think? And why?

Speaker B

00:15:15.830 - 00:16:23.070

It's tricky because what we say in the paper is that I think choosing a selection of them would be the most beneficial on the basis that you'd be able to target different areas.

I think personally, what I would be interested to see, whether it makes a difference or not, would be some sort of just simple display or poster to Kind of encourage parents to speak up as part of fostering that culture of saying it's okay to voice your opinion and to share any thoughts or concerns that you have with us.

So within the stakeholder event, one of the stakeholders described it as being a useful idea because it almost gives parents that permission to be able to speak up if they need to. And I think that's a very good starting point to then build upon.

Hello and welcome today to BJGP Interviews.

I'm Nada Khan and I'm one of the Associate editors of the Journal.

Thanks for listening again to this podcast.

In today's episode, we're talking to Dr. Tom Purchase.

Tom is a GP and a health and Care Research Wales NIHR Doctoral Fellow.

We're here today to talk about the paper he's just published in the bjgp and the paper is titled Co Generating Ideas for Safer Pediatric Care in General Practice with Parents and Stakeholders.

So, hi, Tom, it's really great to meet you and to talk about your work, but before we talk about the study itself, I'm interested to know what first got you interested in pediatric patient safety in general practice.

Thanks.

It's born, I think, out of an extension of the work that we've been doing within the patient safety team within Cardiff University.

So a lot of what we do is looking at incident reports, safety incident reports, and trying to pick out what are the, you know, high level key learning points and takeaway messages from those.

And then within the team, we started to think about, as well as the types of incidents and the types of harms that are occurring within pediatric incidents.

For example, how are parents involved?

And it was a bit of a novel approach to what we normally do, trying to have that extra aspect within the incidents and figuring out how parents were either helping to contribute or to mitigate against the incidents, not just looking at the incidents themselves.

So that was the starting point, really.

And then once we'd started digging into that data and identifying that, actually the majority of the time, which is in one of the papers that was published last year in BJGP, 77% of the reports we were looking at specifically around general practice showed that parents were taking these mitigatory actions that, you know, positive actions that were able to prevent harm or further harm from occurring to their child, for example, chasing results or chasing referrals or importantly, being able to speak up.

And then that highlighted, I think, the importance of parents being able to have a voice and advocating on behalf of their child.

And that really sparked, I think, the interest, and therefore this part of the.

Project, and I think that's a really interesting thing about this paper, is that it focuses on parents and parents not just as observers of care, but as active contributors to safety.

And I wonder what your thoughts are about why that's an important shift in how we think about these things.

I think you've touched on it a bit, but yeah, I'm interested to know a bit more about that.

I think it is a really important aspect of care, but also particularly safety, which maybe is untapped in terms of parents as a resource as to how we can keep children safe.

We know that children on the whole are more, maybe not more vulnerable, but certainly are a vulnerable group when it comes to patient care in general and patient safety.

And that's because they're so heavily reliant on others to speak on their behalf, to make sure somebody else is looking out for their healthcare needs.

And therefore they are probably playing a part within the world of patient safety.

And there are good studies from hospital relating to incident reports that show that parents are capable of picking up issues early on.

They're able to detect issues that maybe other parts or people within the system aren't detecting.

And as I mentioned, our paper from last year specifically looking at general practice showed that parents are able to prevent harms from reaching their children.

So they're playing a substantial part already.

And from a systems perspective, that is mainly parents figuring out workarounds within a system that really isn't, I don't think, designed to support them as well as it could be.

And I guess that's kind of the crux of what you were doing here.

So I guess before we get into findings, just, you know, a quick word about the methods because you worked here with groups of parents to develop ideas for improving pediatric patient safety in, in general practice, in primary care, and then you explored those ideas with a wider group of stakeholders and that included clinicians, managers and policymakers, and then brought them all together to co generate ideas for safer care.

And it was really interesting because the parents generated 16 different ideas for improving safety.

And were there any that particularly surprised you and jumped out at you?

I don't think necessarily any were too surprising on the basis that we.

I don't think I really had any thoughts going into it as to what they might say.

But I guess what did surprise me more was that some of the ideas that we then took forward to the stakeholder group kind of highlighted some disparities or some clear disagreements between the parents who were accessing our services and the people who work within the services.

And how we viewed, I suppose, viewed what's actually happening, that kind of work is imagined and how we think things are going and the work is done.

I guess what the parents were trying to do to come up with the idea is to bridge that gap unknowingly.

I suppose maybe what's surprising is that none of them, I didn't think any of the ideas were necessarily too resource intensive.

You know, I think what was quite reassuring is that lots of what the parents were saying were actually relatively simple things that we might be able to enact or at least adopt or adapt, you know, to our own environments.

And a lot of the ideas seem to center, I think, around communication, access to records and test results, and actually just helping parents to speak up.

And why do you think those themes emerge so strongly?

I think that comes back to maybe that difference between how we like to think the system's functioning and how parents think the system's functioning as healthcare professionals and parents.

Because we know from a thematic analysis we did, which is also going to be published in bjgp, from these discussions we've had with the parents, that a lot of them said they felt the need to fight in order to be heard.

So although within, say, pediatrics and GP training programmes and CBDs and everything we have to do for revalidation, taking ideas, concerns, expectations, collateral histories, making sure we're really considering that the holistic approach is all considered clinically, what you're then getting, I suppose, from the parents is that maybe we're not doing it as well as we could be.

And one parent within the workshop said, I know as a parent you are expected to advocate for your child, but what it surprises me is how regularly you have to do it and sometimes it feels like a full time job.

And I think that one really struck a chord in terms of really emphasizing how much extra effort and how much work parents are feeling they need to put in.

And I think that also implies that the system isn't making it as easy as possible for them to be able to do the right thing.

So I can't necessarily explain unfortunately why they feel that those areas needed to be targeted.

I guess it's because there are barriers that we are not tackling correctly in order to help parents to speak up more efficiently and certainly to be listened to.

And one of the stakeholder priorities was this idea of a designated parent advocate.

Can you tell us a bit more about that idea and why it resonated?

Yeah, sure.

I really liked that one and I thought it was an interesting one because again, it highlighted, I think, a number of issues that we could discuss in a lot more detail.

I know this podcast isn't ours.

I think we could talk about it for a long time.

So that one, I think came out of the need that parents were identifying to sometimes just want to clarify something if they weren't quite sure how to access something or they didn't really know how something worked.

We know that our systems are complicated and one of the issues we found was parents found that just navigating that system was an issue.

So it's one way of trying to work around that.

If there's someone that you can speak to who understands the system, maybe working within the practice or even as a third party, you know, you could go to them and get some advice.

But they also specifically said it's not just kind of system advice, it's also advocacy, help, well being.

If they wanted to give feedback or raise a concern.

It's someone who is very importantly separate from that complaints process.

Because I know I keep talking about the system and how it's designed, but the complaints process, for example, is very specific.

And what we found talking to the stakeholders is that they, they felt that what the parents were asking for here kind of already existed, but in the form of maybe the complaint system, which obviously has a particular purpose, isn't always easy to use.

You know, if you've got to email the practice manager, that might not be something that you want to do.

And parents worried about coming across as a nuisance or having some negative repercussions on them.

So it was an idea of here is someone who's maybe a bit more independent, they know how things work.

I'll be able to get some sound advice from them and that might be able to help me progress or to get my voice heard in a way that wouldn't have a negative repercussion on me.

And I think a lot of GPS listening will be thinking about what this work might mean for their own practice.

And which of the proposed changes do you think are most achievable at practice level?

Is it that about a parent advocate or are there any other ideas that you thought could be achievable?

Thankfully, that was one of the questions that we were asking the stakeholders.

So when we took all of these, the 16 ideas to the stakeholders you mentioned, we specifically said of these ones, which do you think are the most doable and which ones will be the most impactful?

And then we went through each one in turn and plotted them on a matrix to say, you know, to try and come up with an arbitrary way of saying, well, which ones do we think are the most impactful and most doable that we could then suggest to, as you say, practices or readers in a meaningful way.

Where there was most agreement between the parents and the stakeholders, as well as being positioned as the most doable and the most impactful, was asking parents for solutions and feedback.

So parents felt that they weren't being asked enough for their opinions and their experiences when it comes to, well, lots of parts of the process, but obviously in relation to safety.

And then the stakeholders also strongly agreed that actually, if we're going to improve our way of working and integrate the parent voice more, we obviously need to be asking them.

And in lots of other industries, we're obviously asking for feedback all the time, and we don't necessarily do it very well in the NHS or within general practice specifically.

So I think it reflects maybe, you know, a broader issue about patient and public involvement that in.

Specifically in the context of parents, because child safety is so important to them, I think their involvement is therefore seen as a really important role that maybe they're not currently being given the opportunity to fulfill the disagreement or not disagreement.

But the discussions that happened in the stakeholder meeting around this, everyone agreed that it was a good idea, but it was.

How it was then implemented was maybe going to be obviously based on where you are and your population, but also what you were actually asking the parents for.

So whether it's a case of doing something similar to us, where you maybe have a focus group or workshop, or whether you just send out a survey with some specific questions, or if you speak to some individuals with one stakeholder, highlighting that if you do have a significant event or some safety incidents that you've been looking at, are you then talking to the people who've been involved, those parents, and trying to identify the gems that sometimes come out of that in order to identify where you can make improvements that could lead to a meaningful change?

Yeah, I like that idea of involving parents in significant event meetings, or at least taking the results of those two parents, because often I feel like those meetings are kind of closed within the practice, aren't they?

They're not.

Yeah, absolutely.

And there's no reason necessarily that we couldn't.

I think it's just maybe we haven't thought about whether we could or we should.

And then once you start to have those ideas, you know, you can then start thinking about, well, how feasible is it?

How could I manage this?

Or even quality improvement projects or any kind of safety activities, you know, probably could have parent involvement as well.

We're just not necessarily thinking about it in those terms.

One thing I thought was really interesting is that the paper talks about parents as a source of resilience within the healthcare system.

What did you mean by that?

So what we mean by system resilience normally is how adaptable is that system to any change or unpredictability which within all of healthcare, being the complex socio technical system that it is, we are constantly facing unpredictable scenarios.

And you know, those, those interactions between us, the parents, the children, all the other staff, our technologies are always changing, the organizational structures are always changing.

You never quite know how the interactions between all those elements are going to come to fruition or what's going to emerge as a result.

So resilience is facing all of those changes.

If something was to happen, how well can you know you bounce back as a practice or how well are you going to be able to cope with an issue or an event?

And parents being an important part of that system.

Resilience is because not just as a safety net, but also as an information source and somewhere to go or someone to talk to who would be able to, as we mentioned earlier, pick up on when something isn't quite going right, or if they want to challenge a decision.

And from a human factors and ergonomics point of view, we know that when someone is able to advocate or speak up or challenge or help to correct something that supports resilience.

So it's giving the systems all of the opportunities to continue to function safely and correctly that it can.

And I guess having done this work, what do you think is the one thing you'd most like gps to take away about working with parents to improve safety?

If I had to choose one, I think it would be encouraging parents to speak up.

Lots of things we've talked about obviously in this podcast around how we could incorporate them in other ways, but just the simplicity of validating their concerns and considering their concerns as clinically meaningful.

But then creating a culture within the practice where a parent speaking up or asking a question isn't viewed as a criticism, which I think is often the case, or a hindrance and welcoming and proactively seeking out parents insights.

So trying to shift the thought process from parents being passive participants within our system to actively trying to incorporate their voices into what we're doing on a daily basis.

And I'm going to ask sort of a similar question but in a slightly different way.

But if you could implement just one of the ideas from the workshop in your own practice, which one would it be do you think?

And why?

It's tricky because what we say in the paper is that I think choosing a selection of them would be the most beneficial on the basis that you'd be able to target different areas.

I think personally, what I would be interested to see, whether it makes a difference or not, would be some sort of just simple display or poster to Kind of encourage parents to speak up as part of fostering that culture of saying it's okay to voice your opinion and to share any thoughts or concerns that you have with us.

So within the stakeholder event, one of the stakeholders described it as being a useful idea because it almost gives parents that permission to be able to speak up if they need to.

And I think that's a very good starting point to then build upon.

So even though there were other ideas that were maybe considered more doable or impactful, I think that one for me was an interesting one because it could also be done tomorrow.

If you wanted to put up on a display TV in the waiting room or a poster, you could do that very easily and then see whether it made a difference to how parents responded to you in consultations or elsewhere.

Any other final thoughts or anything you want to mention from this work that we haven't touched upon?

I think maybe we just haven't touched upon how inequalities within this space can really hamper advocacy efforts.

And that came through from the discussions with the parents and the stakeholders where there will be characteristics and concerns that certain underserved or minority groups will have that other groups won't.

And when we are thinking about changing our systems, and this will obviously be very population and community dependent, but we need to think about those characteristics and how that might create barriers to being able to either have the confidence to speak up or the ability to speak up and then trying to adapt the system so that they are able to do that more effectively so that they can be heard and listened to.

I think this is a really interesting paper for people to take something away from in terms of reading it and thinking about how things are structured within each practice and then maybe, as you say, thinking about which ideas would be most applicable to their own practice population.

So I think that's really fascinating.

And as you know from the workshops, I mean, there's some solid recommendations here.

So I'd really say to anyone to go back and read it, really.

Thank you.

Yeah.

And I'd add for anyone who is.

Who is interested in looking back at the paper to specifically go and look at the appendix, because unfortunately there's a table in there that was far too big to go into the paper, but it goes into a lot more detail in the stakeholder workshop and the discussions that happen there.

And the quotes that I think are interesting to look at from a practice perspective.

But in summary, I'd say if we can genuinely form partnerships with parents, I think we're more likely to be able to build responsive, inclusive ways of working that ultimately, hopefully would be safer.

Brilliant.

I think that's a great note to end on, Tom, but I just wanted to say thanks very much for joining me to talk about this work.

Not a problem.

Thank you very much for inviting me.

It's been a pleasure.

And thank you all very much for your time here and for listening to this BJGP podcast.

Tom's original research article can be found on bjgp.org and the show notes and podcast audio [email protected] thanks again.

Bye.