Current Literature: 4

Background The Clifton area of Nottingham with a total population of nearly 20 000 and a child population of 4500. Aim To track the changes in clinical services provided by community paediatricians in Clifton from 1983 to 1999. Methods The paper tracks changes through a series of reports produced over time by the paediatricians working in the Clifton area. The 5 reports are dated 1983, 1985, 1989–91, 1995, 1999–2000. Results The child population in Clifton dropped somewhat from 4700 to 3900 during the study period. A child health clinic (CHC) with no appointment system and providing Child Health Surveillance was staffed by a senior community paediatric trainee in 1983. This had transformed into a referral clinic with an appointment system by 1995 (still staffed by the trainee). By 2000, the clinic had added a consultation element for GPs, HVs, school nurses and school support teachers for a session a week and added a clinical psychologist to its staff. Trainees staff the clinics still (a lecturer and an SHO) but an Associate Specialist session has been added to provide better continuity of care. In 1983, each infant was seen 26.7 times (range 9–51): 61% at the CHC (mostly for weighing), 31% at the GP surgery. By 1991, GPs had taken on CHS and the clinic had a formal appointment system but with a ‘drop in’ period when necessary. Total attendances dropped by almost a half between 1989 and 1991, as did those attending for immunizations. Primary care referrals accounted for 15.5% of those seen in 1991. Major diagnostic categories included weight and feeding, development, behaviour and ‘minor problems’. By 2000, there were 3 referral clinics a week with the additional consultation clinic. No CHS was provided. Developmental difficulties (61) and behaviour difficulties (60) now top the list of referral categories and the latter include self‐harm, anorexia, Tourette’s, ADHD and conduct disorder, with 8 of these excluded from school. Medical diagnoses (49) such as short stature, epilepsy and various syndromes come next with child protection referrals (28) and weight and feeding (26) following on behind. Hospital consultants had referred some children to be managed by the community paediatricians. Conclusions The authors point out the invisibility of the changes in community paediatric services compared with the more apparent hospital changes. The lack of regular reporting of community data reinforces this invisibility. However they also sound a hopeful note that the community services have shown a constant ability to innovate and respond to changing demand and that this should stand us in good stead in the future.