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There are now more and more advertisements for ambulatory paediatricians. Ambulatory care is one of the popular new catch phrases within the National Health Service (NHS). Both the Tomlinson report and the King’s Fund document on health care in the capital, advocated the development of ambulatory services.1 2 A British Paediatric Association discussion document introduced ambulatory paediatrics as an option for future development.3 This document gave a broad definition of ambulatory paediatrics as being everything that is non-inpatient, and so included such diverse areas as community paediatrics, child guidance and counselling services, specialist clinic care, and primary care paediatrics. Ambulatory paediatrics is not a specialty but a philosophy and, to a large extent, many paediatricians are already operating an ambulatory service.4 In practice, however, what does ambulatory paediatrics mean, what is the role of an ambulatory paediatrician, and does ambulatory paediatrics make any difference?
I was appointed in 1993 as an ambulatory paediatrician. Working from a hospital base in a district general hospital setting, I share with my colleagues the inpatient load on the general wards and the special care baby unit, as well as the outpatient load. However, my prime responsibility is the development of the ambulatory service, which I have approached in the following way.
The working definition I use is that ‘Ambulatory paediatrics refers to the non-inpatient hospital services and to the provision of care to sick children at home or in their local environment’. The philosophy behind ambulatory paediatrics is that children should not be admitted to hospital unless absolutely necessary and, as much as possible, care should be arranged in their own homes. There have to be changes in the way we work so that children are not coming to the hospital for doctors’ convenience but, instead, only when care cannot be …
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