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The face of primary care is changing fast
The delivery of unscheduled care outside hospital is hugely different from even 5 years ago, with a government initiative of taking the care to the patient1,2 rather than the opposite. The organisation of emergency care for children (and adults) outside hospital and the professionals involved has changed considerably, so the experience an ill child and family may have nowadays may be quite different from “seeing your own doctor”.
The difficulties of the prehospital environment in an acute emergency setting are diverse and have been described elsewhere.3 Most ill children, however, (as opposed to injured children) will at least be examined in a relatively controlled environment, although siblings, washing machines, televisions, and large dogs mean that a gentle “command and control” attitude may have to be exerted on arrival. Lighting may be remarkably poor even inside a house, sometimes removing the capability to assess the child’s colour. Although most general practitioners and others required to attend ill children will encourage surgery attendance to obviate such problems, this is often deemed impossible by carers (particularly to out of hours services), for a variety of logistical reasons. Out of hours, it is also unlikely that whoever attends an ill child will have any access to the patient’s notes and, once pharmacies are closed, prescribing options are limited. Equipment carried for children by the ambulance service, the GP, and out of hours services will reflect their perceived roles, but in all cases may be relatively lacking compared with hospital—for example, pulse oximetry is still in its infancy in general practice.4 Some GPs still do not carry oxygen. The equipment and procedures available to children from the ambulance services vary widely from service to service.5
OVERALL CONSIDERATIONS OF THE NEW STRUCTURE
The new contract for GPs that has …