Dr Alex Maxwell

Head of School Medicine

Meliora Medical Group

Across the UK, schools are increasingly finding themselves on the front line of children’s health – often without the clinical support they need.

Supporting pupils’ physical and emotional well-being is no longer a ‘nice to have’ alongside education – it’s a necessity for engagement, learning, and long-term development. Many schools have invested in strong pastoral, psychological, and medical provision. Yet, for others, a combination of constrained resources, a lack of prioritisation, and rapidly evolving pupil needs has left their health and well-being provision suboptimal and, in some cases, no longer fit for purpose.

The health profile of pupils is changing. Mental health conditions such as anxiety, obsessive-compulsive disorder, and depression are rising¹. Pupils diagnosed with neurodivergent conditions like attention-deficit hyperactivity disorder or autistic spectrum disorder or who experience learning skills challenges are more common². At the same time, lifestyle-related concerns, including childhood obesity, poor sleep, physical inactivity, and a suboptimal diet, continue to grow³.  Expectations from parents and the role and responsibilities teachers play in children’s lives are also increasing, areas that must be monitored and governed. Children’s digital lives also play a significant role, with new and complex health impacts: social media-driven distress, body image concerns, sleep disruption, and screen-related concentration difficulties⁴.

The reality is that many pupils present with concerns that do not fit neatly into one category. They are often experiencing a complex blend of medical, psychological, social, and behavioural challenges. This requires careful coordination, clinical insight, and collaboration with external agencies – but that support is not always readily available.

In the last few months, I supported children in many difficult situations: from a teenager with deteriorating mental health and safeguarding concerns to a child with growth and development issues exacerbated by bullying. None of these cases had a clear pathway – but all required a timely, joined-up response. Navigating these complexities whilst ensuring the integral voice of the child isn’t lost is not easy and something I strive to do as a school doctor.

These situations will be familiar to school nurses, school doctors, pastoral staff, and teachers. They are often the first to recognise when something is wrong. However, in many schools, the ability to act on that recognition is limited. Access to a school doctor is rare – but shouldn’t be. GPs are very overburdened and understandably not able to prioritise a school-age population and give the input schools require in a timely manner. External services are increasingly stretched: mental health teams face impossibly long waits; safeguarding thresholds have risen under caseload pressure. As a result, schools are being asked to manage more but without the resources, training, or systems to do so.

This raises a fundamental question: ‘What should school-based medical care look like in 2025 and beyond?’

This article marks the beginning of a new series, ‘Whole Child, Whole School’, which explores how schools – with a focus on the independent sector – can move toward more integrated, proactive, and lifestyle-informed provision for pupil health and well-being.

Independent schools are often well-positioned to trial new or enhanced approaches. With greater resources, on-site health staff, more flexible infrastructure, and growing leadership support for health and well-being, they have the capacity to test models that offer earlier intervention, reduce strain on families and the NHS, and improve continuity of care. In my own work, I’ve seen how embedding school doctors alongside nurses and school pastoral and health and well-being staff can support decision-making, reduce safeguarding risk, streamline referrals, and give much-needed reassurance to families and staff alike. This integration results in an overwhelmingly positive impact on the pupils’ experience, health, and educational outcomes.

These challenges are by no means unique to the independent sector. State sector colleagues are facing the same challenges – often under greater pressure and with fewer resources. Many are pioneering excellent work, developing innovative pastoral systems and strong referral pathways. NHS-led initiatives like Mental Health Support Teams⁵ have created new models of collaboration. I applaud these efforts and believe we should learn from and share best practices across all settings.
This series draws on examples from the independent sector because it’s where I currently practise and can speak with the most clarity. These are not blueprints, but case studies — offered in the spirit of collaboration, with the goal of supporting all schools to better meet the needs of the children they serve. I am actively building my experience within the state sector, and hope that any insights gained can benefit every pupil, regardless of background. I welcome all and any input from colleagues in this field and beyond!

We also have much to learn internationally. In Finland⁶, pupils receive regular health assessments by school nurses and doctors, supported by psychologists and social workers. In the United States, School-Based Health Centers⁷ deliver a wide range of care on-site, including mental health. In Australia, school-based GP clinics are being trialled to improve access and early support for adolescents.

Here in the UK, there are green shoots. Mental Health Support Teams are expanding amongst other plans in the NHS ‘Long Term Plan’ to improve mental health provision for children. Some independent schools are developing more comprehensive clinical teams that reflect the complexity of pupil needs. Although there are a number of incredible institutions supporting child health, like the Royal College of Paediatrics and Child Health or the Boarding School’s Association, there is no national framework for a modern and multi-disciplinary school-based healthcare system – no shared definition of what “good” looks like and too few examples of truly integrated, lifestyle-oriented care embedded in the fabric of school life.

We need to change that. I know that my team and I are doing so alongside the incredible and dedicated professionals out there in this space.

Over the coming articles, we’ll examine:

• ‘A week in the life of a school doctor’: You could call this my diary – how I work within a school setting – responding to common presentations, supporting staff, and contributing to both individual care and whole-school well-being
• ‘A term in one clinic: the real health landscape in schools’: An evidence-informed look at the most common physical, emotional and behavioural issues seen in schools – and what they reveal about system gaps and emerging trends.
• ‘Lifestyle Medicine in schools: more than a lesson plan’: How schools can embed the principles and pillars of Lifestyle Medicine into the daily rhythm of school life, supported by clinical insight.
• ‘Screens, sleep and social pressure: responding to the digital realities of school children’: An exploration of how the digital world is shaping children’s well-being – from social media and screen time to cyberbullying and how schools and clinicians can respond more effectively.
• ‘Safeguarding: the good, the bad, and the ugly’: an honest and challenging look at the current state of safeguarding in schools and beyond.
• ‘School Medicine: a recommended model for the independent sector’: an exploration of what best-practice school medicine should be.

This is not a call for schools to take on more alone. It is a call for integrating medical expertise into schools and closer collaboration between education and health – for a joined-up approach that matches the complexity of the needs we now see in schools every day.

The evidence is clear: children who are physically and emotionally healthy attend more, learn better, and experience greater long-term outcomes⁸. When health improves, education does too.

Although this first series focuses on the independent sector, I hope to follow it with a companion series focusing more on the state sector – where the challenges may differ in some ways, but children are still children, and the stakes are just as high.

Let’s think boldly, work together, and design school-based medical care that truly meets the needs of the whole child.

Resources and references:

1. NHS Digital (2023). Mental Health of Children and Young People in England, 2023 – Wave 4; Vizard, T., Sadler, K., Ford, T., et al. (2022). Mental Health of Children and Young People in England, 2022. NHS Digital.
2. Green, H., McGinnity, Á., Meltzer, H., et al. (2020). Mental health of children and young people in Great Britain, 2020. Office for National Statistics.
3. Public Health England (2019). Health matters: getting every adult active every day; Office for Health Improvement and Disparities (OHID) (2022). Childhood obesity: applying All Our Health.
4. Royal College of Psychiatrists (2020). Technology use and the mental health of children and young people.
5. NHS England (2019). Mental Health Support Teams in schools and colleges: Trailblazer Programme.
6. Koskinen, S. et al. (2014). School health services in Finland: A national overview. Finnish Institute for Health and Welfare.
7. Love, H. E., Soleimanpour, S., Schlitt, J., et al. (2019). Twenty years of school-based health care growth and expansion. Journal of Adolescent Health.
8. Basch, C. E. (2011). Healthier students are better learners: A missing link in school reforms to close the achievement gap. Journal of School Health, 81(10), 593–598.