The NHS could be a year away from a “crisis” in the care given to children, the new president of the Royal College of Paediatrics and Child Health has told HSJ.

Dr Hilary Cass, consultant in paediatric disability at Guy’s and St Thomas’ foundation trust, said action needed to be taken now to address serious problems developing within the paediatric workforce.

She said the speciality was facing a severe shortage of middle grade doctors, creating gaps in staffing rotas which in turn raised safety risks.

As a result, paediatrics was facing “very serious risks but was not quite in crisis yet”. However, she warned if the NHS did not invest in the necessary changes “then there’s a chance we could be saying that in a year’s time.”

One solution she said the college was supporting was the idea of consultants taking on the middle grade rota posts. The profession has an over supply of consultants and the solution would not only close rota gaps but further improve safety by providing more senior cover throughout the day and night.

She said: “Our mortality rates for children aged 0 to 16 is higher in the UK than other parts of Western Europe. There are failings in primary and secondary care that we have got to address and it is not acceptable that the sickest patients can sometimes be seen by the most junior doctor.

She acknowledged that consultants cost more to employ than middle grade doctors, but said: “If you deliver better quality of care and better decision making about who you admit and who you don’t admit and you get things right first time, then in the longer term that can be cheaper.”

This model of care is already being piloted in some parts of the UK. Dr Cass told HSJ the NHS needed to move more paediatric care out into the community with centralised hubs able to offer specialised hospital care.

She said hospitals could be “paediatric magnets” but that primary care could be a better setting for some services while the public would be prepared to travel further for specialist care if they were confident in the expertise on offer.

This would include closer working with the nursing profession such as advanced nurse practitioners.

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