Pioneers, paediatricians and public health: the evolution of community child health services, Clifton, Nottingham 1983-1999.

Since 1976 developments in the training and services provided by general practitioners and community paediatricians have led to a series of changes in clinical services provided for children in the community. A series of studies carried out in the Clifton area of Nottingham from 1983 to 1999 illustrate this. A changing pattern of service delivery is reported in which clinical medical officers provided a largely primary care service in 1983 developing into a paediatric secondary care service in the next decade with the primary health care team having taken over the role of child health surveillance. The community services in the 1990s were taking over the investigation and management of paediatric problems previously seen in the hospital outpatient clinic. The studies illustrate the advantages of locally based services in terms of ease of parental access and consultation between the primary health care team and specialist children's services.