Community paediatrics moves on--an analysis of changing work patterns 1994-97

To describe the current clinical workload of the modern community paediatrician; to outline the changes in this role over recent years and examine the reasons for these.

The design is a retrospective analysis of data routinely collected for contracting purposes. Nottingham community paediatric service 1994-97 is the setting.

These are the characteristics of patients seen, sources of referral, locations of clinical contact, referral rates by area.

36,710 appointments were offered over the time period studied. The non-attendance rate was 17%. Pre-school children made up the largest group seen. Most referrals were from health visitors (23%) and school nurses (29%). There has been a small but significant increase in the numbers of children seen who have developmental problems and disability, and due to child protection issues between the time periods. There has been a shift in the proportions of children seen in a local health centre referral clinic (9.8% increase during 1994-97) rather than in a school setting. Twice as many children are referred to the community paediatrician from inner city areas than from the surrounding county areas.

The transfer of child health surveillance to the primary health care team and the increased training of community paediatricians, has resulted in community paediatricians developing an increasingly specialised role particularly in the areas of child growth and development, disability, social and behavioural paediatrics.