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Confusion may arise in the minds of UK-based readers of this article due to the terminology used in this article, which differs slightly from the notion of “community paediatrics” in the UK.
Whereas in the UK all children receive primary care from a General Practitioner (GP), who then makes referrals to secondary and tertiary level specialists as required, the Israeli “community paediatrician” referred to in this article is actually a primary care paediatrician, who delivers all aspects of medical care to the infant and child, much as the GP in the UK does for both adults and children.
The majority of children and young people in Israel receive primary medical care from a fully qualified paediatrician who has achieved consultant (or specialist) status with a minimum of 4.5-5 years of general paediatric training. Only a minority of children and young people in Israel receive primary medical care from a Family Physician (equivalent to the UK “GP”). Paediatricians in Israel can work either in primary care or as paediatricians with an additional sub-specialty in hospitals, or can work in both settings in parallel (often working part or full time in hospital and moonlighting in primary care).
In the UK, the “community paediatrician” is a second tier specialist who deals in specific medical areas , and accepts referrals from the primary medical carer (GP), via a selective referral system. Community paediatricians in the UK usually provide neuro-development...
In the UK, the “community paediatrician” is a second tier specialist who deals in specific medical areas , and accepts referrals from the primary medical carer (GP), via a selective referral system. Community paediatricians in the UK usually provide neuro-development and neuro-disability assessments, including autism, but also provide medical services related to child protection and child abuse; children in care of the state (“looked after children”), adoption panels, child death inquiries, statutory advice for children with special educational needs (currently Education and Health Care Plan), special schools and other specialist areas which are developed locally. The UK community paediatrician cannot be accessed on demand and at short notice in the same way as a UK GP or an Israeli primary paediatrician are.
Therefore, the title of the article “Community paediatrics in Israel” actually refers to a system of primary care for children and young people, with on-demand access for parents or children, rather than to a specialist second-tier service. However the changes described in the article refer to expansion of the existing training to incorporate additional expertise in topics such as mental health, behaviour and ADHD, which are increasing in prevalence and demand for service (in Israel as in the UK).
Another term in the article which might cause confusion is “resident” or residency, which in the UK would be equivalent to “registrar”.
The first paragraph in the article ends in a statement that “management of paediatric problems in the community (Israel) is done by paediatricians who had not completed subspecialty training”. This actually means that they are fully trained consultant paediatricians, but are not necessarily certified in a subspecialty, such as paediatric respiratory, neonatology, neurology or haematology, etc.
Whereas in the UK not all paediatricians are at consultant (specialist) grade (i.e. “non career grade paediatricians”), in Israel the only non-consultant grade paediatricians working in hospitals or primary care are those who are in paediatric training (registrars by UK terminology , or “residents” in USA terminology), which culminates in achieving status of specialist /consultant.
Paediatricians in the UK are usually either “community, “acute” (hospital general paediatricians), or specialist in paediatric sub-specialities (mostly based in tertiary level hospital settings).
In Israel many paediatric subspecialties are available both in hospitals and in the community, some of which require a referral from the primary paediatrician, but others can be accessed directly by parent initiative (for example paediatric orthopaedic surgeons or neurologists).
All people permanently residing in Israeli (I have avoided the word “resident” here) are covered by national health insurance, however, as opposed to the single system (NHS) operating in the UK, in Israel four competing public health organisations (Health Funds) operate, delivering a basic universal “basket of services” , and competing with each other by offering increasing levels of excellence or diversity of additional services.
This comment will, I hope, clarify some of the information presented in the article by Porter et al.
Dr Naomi Gerson-Sofer
Consultant Community Paediatrician
Oxleas Foundation Trust
(Formerly Director of Child Development Centre in the Western Galilee Hospital, Israel)