Aims To assess the value added to patient care by the input of the paediatrician following referral to a general paediatric outpatient department.

Methods The authors received 200 general practitioner (GP) referral letters from the Primary Care Trust (PCT) over a 2-year period. The authors excluded letters to other hospitals and to non-medical specialties, such as paediatric surgery or ENT. A group of paediatricians reviewed both the referral letter and the return correspondence, and made a judgement on the relevance of the referral to hospital.

Results 70 pairs of letters were analysed. In 45, patient care was improved by referral to secondary care. In 25 it was felt the referral could have been avoided.

The referrals which enhanced patient care:

• ▸ suspicion of serious underlying conditions

• ▸ unclear diagnosis

• ▸ treatment instituted by GP had not resolved the problem

• ▸ further hospital investigation and management required

However, there were instances in which improvements could be made:

• ▸ lack of information on the referral

• ▸ incorrect diagnosis on the letter

• ▸ referral being directed towards the wrong individual

Other letters highlighted education and training issues:

• ▸ knowledge or confidence gap in the GPs' training

• ▸ lack of confidence in treating children

• ▸ lack of confidence by the GP in his own diagnosis

This carries a cost implication—if 36% of the 1268 referrals to general paediatrics last year were potentially avoidable, this would represent a saving to the PCT of £110 000.

Conclusions The authors advocate an integrated approach to healthcare for children in which GPs have easy and ready access to advice from paediatricians. There is a shortage of paediatric resources, partly due to different working patterns after the introduction of the European Working Time Directive. We must ensure the most appropriate use of scarce resources. With improved communication, the numbers of children requiring hospital review can be reduced. The authors feel that better links between primary and secondary care will improve patient satisfaction and GP education. In addition, parental confidence in GPs will increase as they become more confident in managing the child's condition. This will result in fewer avoidable referrals to secondary paediatrics.