• out of hours care

It is now just over 25 years since Donald Court reviewed paediatric services in the UK. The only major recommendation that was not eventually implemented was the concept of a general practitioner paediatrician (GPP).¹ Court recognised the importance of strengthening the care of children wherever they might be: in the hospital, community, or in general practice. Recent years have seen an integration of hospital and community paediatric services which has resulted in better care, especially for vulnerable and disabled children. The government’s new Green Paper,² which puts an emphasis on integration of education, social care, and aspects of health, does potentially threaten to destabilise the integration of paediatric services. We must be aware of the danger and find a way of working across boundaries. The green paper was driven by the horror of the murder of Victoria Climbié and we must all try to ensure that in a further 25 years we are still saying that we have not learned the lessons that date back to the tragedy of Maria Colwell in the 1970s. Paediatric services are inevitably changing and child protection is just one of the driving forces. The implementation of the European Working Time Directive for trainee doctors in 2004, changes in morbidity, greater public expectation from parents, and the falling birth rate are just some of the issues which force us …