Primary care of children: the unique role of GPs

Abstract

![][1] The provision of medical care for children and young people is changing. Access to GPs has reduced since 2004 due to changes in out-of-hours care. In-hours, the Quality and Outcomes Framework (QOF) has shifted priorities away from providing care for children. Few childhood conditions fall inside the QOF, and consultation rates have increased for all age groups except children.1 Most parents prefer to see their own GP but accept that out of hours this may no longer be possible. Yet out-of-hours services are no substitute for GP care, often directing parents to seek several consultations for the same problem,2 costing families time, money, and increasing anxiety, and potentially introducing delay in diagnosing and treating serious illness. This has impacted on paediatric services in hospital accident and emergency departments which are already stretched and under pressure to achieve waiting time targets, resulting in increased inappropriate short stays in hospital. One in four children aged under 18 years (3 million) attend emergency departments each year;3 short stay admissions (less than 48 hours) have increased by over 40% in a decade.4 At the same time acute paediatrics is changing very fast, with the emergence of Paediatric Assessment Units, a new model for paediatric community services open for 18–24 hours, potentially almost completely replacing … [1]: /embed/graphic-1.gif