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Who should provide primary care for children?
  1. C M Ni Bhrolchain
  1. Correspondence to:
    Dr C M Ni Bhrolchain
    Huntingdonshire PCT, Primrose Lane, Huntingdon PE29 1WG, UK; Clionaniblineone.net

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“Primary health care is essential health care ... made universally accessible to individuals and families in the community ... It is the first level of contact of individuals ... with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process”.

Traditionally,1 UK general practitioners (GPs) have provided primary care for all age groups. However, the Royal College of Paediatrics and Child Health (RCPCH) has recently proposed that paediatricians should take on primary care for children. This article assumes that this proposal includes all the elements of primary care paediatrics as seen in those countries where primary care paediatricians already practice: assessment and management of acute illness, ongoing management of chronic conditions including disability, and primary prevention including immunisation and “well child” visits. Does this proposal withstand scrutiny?

The increase in hospital admissions for acute illness appears to be due to primary care problems managed by secondary care doctors

There has been a significant increase in the number of children admitted to hospital for acute illness.2 Those who promote the concept of primary care paediatricians often cite poor primary care as the reason.

The evidence challenges this theory. Boyle et al showed that referrals from primary care to Derbyshire Children’s Hospital showed no increase between 1994 and 1998.3 MacFaul et al found that admission in Yorkshire was more likely after self-referral to A&E.4 Admission was also related to social disadvantage and presentation at night. In 1996, …

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