Paediatrics in Primary Care

“The concept of the generalist paediatric practitioner is not new. As far back as 1976, the Court Report Fit for the Future introduced the concept of the GP Paediatrician, intended to be a GP with additional training providing services to children. Three decades later, the Royal College of Paediatrics and Child Health suggested that paediatricians should take over the care of all children, and follow the USA and European practice in developing the concept of primary care paediatricians."

Gerada C. Child health: general practitioners (GPs) and the care of children and young people. London J Prim Care (Abingdon). 2010;3(1):8-9. doi:10.1080/17571472.2010.11493288

“Paediatric emergency attendances and admissions are rising year-on-year [source], and greater intervention at the primary and community level is needed to prevent unnecessary hospitalisation of children. Our findings show that beds in general paediatric wards are being occupied by [up to 6% of] children with mental health problems. This is not an appropriate location for children in acute mental distress and reflects a lack of community resources and a need for better integration of care.”

“Snapshot of general paediatric services and workforce in the UK”, published in 2020 by the RCPCH

“One concerning observation is that many children who end up in urgent and emergency settings do not necessarily require such care. Despite the high attendance rates, there was no proportional increase in admissions. A recent study revealed that approximately 40% of paediatric ED attendances are likely to be classified as 'non-urgent,' with an even higher proportion observed among young children and out-of-hours visits. The challenges in accessing primary care and the higher demand for primary care services are key drivers behind the influx of patients seeking urgent and emergency care.”

— “Right Place, Right Care: Learning the Lessons from the UK Crisis in Urgent & Emergency Care in 2022”, published in 2022 by the Royal College of Emergency Medicine (RCEM), contributed by the Royal College of Paediatrics & Child Health (RCPCH).

“A large number of ED presentations in children within a large English region are NUAs (non-urgent attendees) and do not require the care provided by a type 1 ED. Our data suggest there are particular groups of children for whom targeted interventions would be most beneficial. Children under 5 years would be such a group, particularly in providing accessible, timely care outside of usual community care opening hours.”

— Simpson RM, O'Keeffe C, Jacques RM, et al, Non-urgent emergency department attendances in children: a retrospective observational analysis, Emergency Medicine Journal 2022; 39:17-22.

“Over the past decade [2007 to 2017] since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.”

Ruzangi J, Blair M, Cecil E, et al, Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017, BMJ Open 2020;10:e033761. doi: 10.1136/bmjopen-2019-033761

“Rising needs in the child population and demand from families are most likely contributors to the patterns of overall increasing healthcare use by children seen here. 8 Preterm birth is increasing and is the single biggest cause of neonatal morbidity and mortality in the UK and other countries where survival rates are increasing. 25 Thus, rising emergency admissions in infants could be explained by a growing morbidity burden in infants compared with other children. Recurrent admissions in children and young people with chronic conditions contribute substantially to total emergency admissions.” 26

Ruzangi J, Blair M, Cecil E, et al, Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017,, BMJ Open 2020;10:e033761. doi: 10.1136/bmjopen-2019-033761

“Hospital emergency care may be appropriate for many children and young people but there are also those who may, with appropriate support, be safely cared for outside an emergency care setting. This report has identified potential areas where improvements in care outside the hospital emergency care setting may lead to reductions in A&E attendances and emergency admissions.

However, if there are insufficient resources and alternatives to the emergency hospital care setting or other weak links in the system, it may become difficult to reduce hospital emergency care activity and improve quality of care for children and young people.”

Keeble E, Kossarova L, Watch Q. Focus on: emergency hospital care for children and young people. what has changed in the past 10 years? research report, 2017.

“Of 115 000 children attending the ED over the study period, a complete set of data were available for 13 099 categorised as ‘GP appropriate’; of these, 8404 (64.2%) were managed by GPs and 4695 (35.8%) by ED staff. Median duration of ED stay was 39 min in the GP group and 165 min in the ED group. Children in the GP group were less likely to be admitted as inpatients and less likely to wait >4 hours before being admitted or discharged, but were more likely to receive antibiotics. Treatment costs were 18.4% lower in the group managed by the GP.”

Leigh S, Mehta B, Dummer L, et al. Management of non-urgent paediatric emergency department attendances by GPs: a retrospective observational study. Br J Gen Pract. 2020;71(702):e22-e30. Published 2020 Dec 28. doi:10.3399/bjgp20X713885

(P values, odds ratios and confidence intervals removed for readability)