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Integrated care: putting principles into practice and becoming the paediatrician of the future
  1. Kate Dharmarajah,
  2. Chloe Macaulay
  1. General Paediatrics, Evelina London Children's Hospital, London, UK
  1. Correspondence to Dr Kate Dharmarajah, General Paediatrics, Evelina London Children's Hospital, London, UK, SE1 7EH; katedharmarajah{at}

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Our systems need to change: UK child health outcomes are poor.1 There is a clear divide between community-based general practitioners and hospital-based paediatric services. Similar issues arise across many developed nations with the development of two distinct systems: acute hospital paediatric services and separate primary care paediatricians, with links often fragmented. There is evidence that this delivers neither seamless nor equitable care.1 Integrating care around population needs is the direction of travel. Definitions of integrated care vary, but the National Health Service (NHS) England defines it as ‘giving people the support they need’ and ‘removing traditional divisions’. The recent UK restructure into integrated care systems intends to facilitate improved collaboration and equity of health and care across geographies. Within child health, the Royal College of Paediatrics and Child Health’s (RCPCH) 2040 project describing future models of care has the ‘development of integrated care for children and young people at scale across the UK’ as a key goal.

But a change in health systems will require a health workforce with different skills. UK postgraduate paediatric training currently prioritises training in hospital and acute care settings. The 2012 UK Shape of Training report called for a flexible and adaptable workforce trained to meet changing population needs. The RCPCH’s ‘Paediatrician of the Future’ document acknowledges that training needs to adapt and evolve to prepare paediatricians for their future roles.2

There is a disconnect. How do we achieve the workforce we need? How do we train in the ‘now’ …

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  • Twitter @drchloemac

  • Contributors KD and CM conceptualised and cowrote the paper. KD is the first author and CM is the senior author. Both authors approved the final manuscript and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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