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There is something timeless about childhood, but child healthcare is as subject to the fads and fashions of the era as is the nurturing process.1
This article has been commissioned at a very interesting time in the development of paediatrics in the UK and the rest of the world. In the UK, we are in an era of unprecedented change to our National Health Service, and much consideration is being given to how we should provide child healthcare services for the millennium in response to what appears to be an inexorable demand from the public. Future proofing our medical students and trainees in paediatrics so they can deal with the challenges posed by the millennial morbidities will be an important objective of any undergraduate and postgraduate education program.2 3 Among these challenges are child mental health disorders, learning difficulties, intentional and unintentional injury, obesity, poor immunisation uptake and increased long-term survival of children with chronic illness and neurodisability. There are a number of other drivers pushing us to further develop community services in health care, including the shift in government policy towards the development of polyclinics and community specialisation in most medical areas.4 5 Technological advances have allowed very sick children to be cared for at home with assisted ventilation and quality environmental adaptation coupled with highly skilled nursing support.
There are clearly expectations from patients and parents of care being delivered as near to home or school as possible and that the care should be seamless without perceived interruption across the primary/secondary care divide. That this is occurring globally requires a radical rethink on how teaching at undergraduate and postgraduate level should be delivered.6
There are also a number of barriers to the further development of community child health which include problems with recruitment, where …
Competing interests: None.