A retrospective study was undertaken on the Isle of Man to see if there was a significant difference in the appropriateness of management of newly identified health problems between routine school entrant medical (routine SEM) and the recently introduced selective school entrant medical (selective SEM) and nurse school entrant assessment (nurse SEA). The study included advice and reassurance as an appropriate health outcome. In total, 602 records were reviewed and a chi-squared analysis undertaken. No significant difference in appropriate management was found between the two procedures when hearing, cardiovascular and testicular health problems were excluded. These health problems were excluded because the screening methods were not directly comparable and disadvantaged the school nurse. Future changes in nurse protocol were identified to reduce unnecessary referrals. The study supports the trend away from routine screens towards health promotion and ongoing surveillance by the school health service in partnership with parents, pupils and teachers as recommended in Reference 1.