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Paediatric primary care in Europe: variation between countries
  1. Terence Stephenson
  1. Correspondence to Professor Terence Stephenson, President, Royal College of Paediatrics and Child Health, Theobalds Road, London WC1X 8SH, UK; t.stephenson{at}ich.ucl.ac.uk

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Diego van Esso and colleagues1 describe the various European systems of primary healthcare for children. This survey raises important questions about how primary care is defined, the diversity in the timing and number of scheduled healthcare visits for children and how physicians are trained to care for children.

Definitions and data

‘Paediatric primary care’ could have many interpretations. The classification of the paediatric primary care systems in this survey was based on which professionals (paediatrician or general practitioner (GP)/family doctor) cared for more than 75% of the paediatric population in the public healthcare system of each participating country. ‘Primary care paediatricians’ can also mean different things in different countries. My definition of a primary care paediatrician would be, as is the case in the USA, for example, that the parent can take their child for consultation and treatment directly to a paediatrician without the need for referral by any intermediary. Moreover, in a public care system, direct consultation with a primary care paediatrician ought not to carry a financial penalty to ensure equitable access. In Australia, for example, if the child is referred to an ‘office paediatrician’ by a family doctor/GP, the insurance system will re-imburse most of the cost. If the parent takes the child directly without referral, the parent bears the majority of the cost. Therefore, in reality, few children are taken directly to paediatricians by their parents. The UK has both hospital-based and community-based paediatricians. However, community paediatricians generally see children referred to them for a second opinion by the GP, health visitor, school nurse or social worker and are therefore ‘secondary’ or ‘tertiary’ specialists working in a primary care setting. There are also primary care practitioners who are neither GPs nor paediatricians, for example, community paediatric nurses. Again, in the UK, their involvement in a child's care is …

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