A career for child health doctors.

The Court Report' was a prescription for more competence in child health care, more emphasis on prevention, and the integration of therapeutic and preventive child health services. These represented the underlying philosophy and spirit of Court that was accepted and commended,2 and recently re-affirmed3 as a starting point for alternative patterns of health services for children, after the rejection of the Court proposals in 1978. Since then little progress has been made in the application of this philosophy and fears that have been expressed for the future of the child health services4-8 have not been unfounded. There have been many signs that the unity of the community child health services is breaking up as the school health service is being allowed to run down. The use of changes in organisation to help achieve integration has been abandoned; instead it is anticipated that integration will happen as a result of training.9 No one has dared to predict how long this might take. Consequently general practice with ambivalence and community medicine with relief have together ensured the indefinite continuation of a third force of doctors to staff these community services. This in itself need not be a totally unmitigated disaster for children since at least their community health care could still be provided by doctors with special interest and expertise in paediatrics. Sadly, the needs of children have been submerged beneath the ambitions of factions. At the Annual Representative Meeting of the BMA in 1981 a motion that aimed to enhance the training and expertise of clinical medical officers (CMOs) as a holding operation was defeated, and only grudgingly was another motion adopted calling on the Central Committee for Community Medicine (CCCM) to continue to negotiate a career structure for community health doctors.'0 The CCCM has now responded by approving in principle a report by its Community Health Doctors Subcommittee," which exceeded its remit in discussing training and like a bull in a china shop has overturned the delicately poised under-standings already reached. It defiantly turns its back on any trend towards integration. It goes back on the principle of specialisation in the community health services, and it seeks to give back to senior clinical medical officers (SCMOs) the archaic and unethical function of "clinical management of CMOs both full time and sessional." The report shows a lamentable interpretation of the Health Service-needs of children and of self-preservation on the part of …