ABSTRACT
Before 1974, the care of children outside hospital in the UK was undertaken either by general practitioners (GPs) or by community health services, which were part of the local authority as opposed to the health authority. Reforms in 1973 (the National Health Service Reorganisation Act 1973) brought together most of the child health services under a ‘health’ umbrella. The government commissioned a review chaired by Donald Court, which reported in 1976 and set out a blueprint for the care of children. This integrated vision of child health care moved much of the routine work provided by community child health services – vaccination, child health surveillance, school health – to general practice under the care of a general practitioner. The more specialist paediatric aspects of the community health services – adoption and fostering, child protection, developmental paediatrics particularly in relation to special schools – were to be undertaken by consultant community paediatricians. Although it has taken time, many of Court’s recommendations have come about. Consultant paediatricians, working mainly outside hospital, have gradually replaced retiring senior clinical medical officers and most have a primary general paediatric qualification (MRCP[UK] or MRCPCH). General practice paediatricians have not emerged in the UK, and vaccination and child health surveillance are now performed by health visitors and GPs.
