• General Paediatrics
• Health Service
• Outcomes research
• health policy

Our inboxes are full; papers, statements, alerts, guidelines, standards, systems, networks, interest groups, key performance indicators, job plans, appraisals, revalidation, educational supervision and training, research demands, undergraduate curriculum, continual professional development and somewhere there are the patients we look after. When do we stop and review our priorities? How do we decide what journals to read? What statements to digest? What new systems to develop that will optimise care for our patients? It seems impossible.

Here is one landmark publication that every paediatrician must have read: the Nuffield Trust's briefing on new models of care for child health.1 The Nuffield Trust has a long track record of commissioning research on how to improve the health system in the UK. The document lists current dilemmas in delivering paediatric care, makes the case for a fundamental change in how this is delivered and critically appraises 12 novel models of paediatric care. As a community of paediatricians we need to respond to the challenge. We need to stop and reconsider how we deliver our service to children (including infants), young people (CYP) and their families under conditions that seem to become more demanding than ever (given a cash strapped National Health Service (NHS)). We cannot do this on our own. We will have to come out of our silo, work and integrate with primary care and other, non-medical, services for children. Most importantly we need to listen to our patients and families and respond to their needs.

Why is this document important? Child health mortality and morbidity patterns have changed over the last 40 years. Epidemiological data show a transition from primarily acute infectious diseases as the major causes of death to non-communicable causes in CYP with complex and chronic conditions. In the UK the health outcomes for CYP are some of the …