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Do we need to change the way we deliver unscheduled care?
  1. Colin Powell
  1. Correspondence to Dr Colin Powell, Department of General Paediatrics, Children's Hospital for Wales, Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff CF14 4XW, UK; Powellc7{at}

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Admission to hospital can have a major impact on children and families. Unnecessary admission suggests a failure in the system. Gill et al have analysed hospital episode statistics for children less than 15 years in England between 1999 and 2010.1 They confirm anecdotal evidence that there has been an increase of 28% in emergency admission rate over the last decade with a persistent year on year increase from 2003 onwards. There has been a twofold increase in the number of children admitted for less than a day with short-term illness. An increase in upper respiratory tract infection admissions by 22% and lower respiratory tract infection admissions by 40% illustrates their findings and they also show admission rates for chronic conditions falling by 5.6%. This effect has been shown particularly in children aged 5 years and less.

This is a temporal association, which of course does not infer causation. However Gill's conclusions present the paediatric community with a huge challenge. They conclude that this increase in short-term admissions represents a systematic failure in primary and hospital care. Solving this problem is likely to require a restructuring of the way we deliver acute paediatric care. Although this is very complex with multiple factors, Gill's main conclusion is that the timing of the rise would implicate two main issues; the National Health Service (NHS) contractual arrangements allowing general practitioners to opt out of providing cover ‘out of hours’ and the impact that the 4-h wait target in the emergency department (ED) has had on patient management.

So what is it in the system that is failing? Do these data really suggest a failure of the way primary care services are provided? Is …

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  • Competing interests None.

  • Provenance and peer review Commissioned and externally reviewed.

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