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GPs to lose lead role in paediatric care

By Nigel Praities

A new breed of specialist GP is set to take on paediatric care from hundreds of practices, in a move the profession's leaders claim will split responsibility for care of children and adults.

A Londonwide strategy document unveils plans for ‘paediatric primary clinicians' to lead on the care of children and spearhead a huge shift in the burden of paediatrics from hospitals to primary care.

The Healthcare for London plans, developed under the initial leadership of Lord Darzi, are strikingly similar to those revealed in March by NHS Yorkshire and the Humber, but watered down after protests from GPs. The London strategy could now become a model across the UK, as Healthcare for London's polyclinic plans did.

It has drawn an angry response from leading GPs, with RCGP vice-chair Dr Clare Gerada branding it a ‘terrible' idea that would deskill GPs and leave them subservient to community specialists.

But the strategy document, launched on behalf of NHS London last week, makes it clear change was needed because of deficiencies in the current standard of paediatric care – saying 40% of GPs had received no paediatric training.

‘Children's health in the UK is not as good as it should be. There are complex reasons for this, including changing disease burden and the way medical services are provided.

‘There is a need for a new kind of paediatric primary care-based clinician, who will play a heightened role in unplanned and planned care of children and young people. Primary care paediatricians are the mainstay of paediatric care in many countries,' the report said.

It added that the role would combine ‘the qualities of a GP with those of a paediatrician, providing breadth as well as depth of skills'.

The new role would work in a team including GPs, who would receive additional paediatric training.

Most hospitals in London have been earmarked for the launch of new child urgent care centres, dealing with a whole range of minor problems such as rashes and constipation, as well as managing long-term conditions such as diabetes and asthma.

Dr Gerada, who was the college's lead for child services and is a GP in south London, said the proposals would exclude GPs from paediatric care and lead to them becoming unable to recognise signs of serious illness in children.

‘Gradually they muscle in and remove what is basic general practice care – suddenly you have to have specialist training to look in a child's ear.

‘That is what happened with obstetrics. For 10 years we had midwives, then suddenly they disappeared and we forgot how to do it. This will increase the risk to children and not decrease it.'

Dr Eric Kelly, a GP in Doncaster and senior clinical adviser to NHS Yorkshire and the Humber on its post-Darzi children's pathway, said its final model had not yet been decided.

‘We initially talked about a children's GP model, but that didn't go down well with the profession so we have moved towards teams of appropriately trained professionals – such as specialist nurses.'

Dr Andy Mitchell, medical director for NHS London, said: ‘What we are asking for is that if GPs deal with children they have the experience to deal with them appropriately. They will have more opportunities for training, particularly if we are able to move some expertise out of hospitals into a polysystem.

‘This is an issue for the whole country, but because we have such a high rate of attendance at hospital we have a particular problem in London.'

Child specialists: the London strategy could become a model across the UK Child specialists: the London strategy could become a model across the UK What children's GPs will do

• Be the mainstay for unplanned and planned care of children and young people in the community
• Work as part of the ambulatory care team at local hospitals, instead of inpatient care
• Lead multidisciplinary community teams of GPSIs, specialist and community nurses, and paediatricians
• Take a significant chunk of A&E activity and outpatient appointments for minor problems and the care of children with long-term conditions

Source: Healthcare for London, Meeting the Needs of Children and Young People: Guide for Commissioners, November 2009

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