Will deprived areas still need community paediatricians? An unpopular hypothesis.

Community paediatricians have traditionally provided primary preventive services. The new GP Contract encourages GPs to provide such services within practices but practices in deprived areas may be less able to do so than more affluent practices. This paper attempts to analyse the role of a community paediatrician in a deprived area of South Sefton (Merseyside) HA in providing primary care both before and after the new contract, and the effect the contract had on the involvement of GPs in preventive health care. Only 20% of immunisations and 5% of child health surveillance (CHS) were done within practices in 1989. This rose to 34% and 16% respectively by 1991, but community clinic attendances also rose by 26%. Immunisation uptake improved from DT & Polio 77%, Pertussis 51% and Measles 37% to 98%, 87% and 98% over five years. The identification of problems before school entry was poor, but improved from 31% to 51% over three years. Most problems were identified by professionals during CHS and school health checks rather than being presented by parents. Increased recognition led to an increased need for 'secondary level' support and follow-up of problems. The GPs in this area needed the support of a community paediatrician to provide comprehensive preventive health care. Such areas may need to explore alternative models of care to meet child health needs.