General practitioners must adapt to the changed spectrum of illnesses

The British model of general practice is rightly admired.1 2 Explicit responsibility for a defined population facilitates a public health dimension to health care. The training emphasises teamwork, consultation skills, management of undifferentiated symptoms, and the integration of psychosocial and biological aspects of health and illness in the context of the family and community. These skills are crucial for working with children and young people and the recently published national service framework for children has a whole section on primary care.3 ^w1 Therefore, to question the future of children's health care in general practice may seem perverse, but there are several causes for concern.

Although serious acute childhood illness has become less common, both professionals and parents worry about overlooking potentially life threatening conditions. When a child is ill outside surgery hours, parents accept that they are unlikely to see their usual doctor and the new contract permits general practitioners to opt out of 24 hour responsibilities.^{w2 w3} Out of hours services, …