• primary care paediatrics
• paediatric nurse practitioner
• primary care paediatrician
• locality child care teams

The central objective of paediatric primary care (PPC) should be the integration of preventative and curative health services. Delivering this objective will not be simple or the same in different health districts, but it would achieve a level of primacy if managerially it was the responsibility of the Primary Care Trust (PCT). In my opinion there should no longer be any distinction between the community paediatrician and the conventional DGH based generalist. Both need to be confident working in hospital and community; in order to understand chronic illness clinicians need to have a familiarity with home, community, and school. We need evidence based pathways of care so that a child’s need is met by the most appropriate health professional in a convenient child friendly environment and where the outcome reflects the quality of decision making at each stage. Much “secondary” care previously undertaken in hospitals is now undertaken by general practitioners, specialist nurses, and consultants in the community. The boundaries of ambulatory primary/secondary care are becoming increasingly blurred.

In 1976 the role of a general practitioner paediatrician was described but found little favour.² Even so in many practices now, certain partners are assuming …