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and employing authorities are being asked to review their consultant requirements to achieve a consultant led service. The increase in the numbers of consultants previously recommended by the British Paediatric Association4 is supported in the report; this will mean a further increase in training grades. In future, training in paediatrics at all levels will need to include work in hospitals and the community, and doctors in career grades, too, will increasingly work in both settings. Census data for 1990 and 1992 from the British Paediatric Association showed that there were too few paediatric medical staff with sufficient experience to provide emergency cover in many acute paediatric units. This problem could at least partly be relieved if full use was made of all the medical resources available, a point emphasised recently by the Audit Commission.' One danger is that the community service could lose out to the acute workload of the hospital service, and this would need to be monitored by either the purchasing authority or the consultant paediatricians. What will be the future for the clinical medical officer? They will be offered three choices: direct regrading, seeking a training post, or retaining their posts. Senior clinical medical officers may also apply for consultant posts. The report recommends a relaxation of the 10% restriction on staff grade numbers and a mechanism to allow appointment (in certain circumstances) to a consultant post without advertisement. It also envisages a long term need for non-consultant career grades, but when the consultant led combined child health service has been brought into full operation many of these posts may well be supplanted by training grades. Nevertheless a way will need to be found to provide continuity of care for the child and family in certain specialised aspects of the work. The working party's proposals are of great importance to all doctors working in the child health service, and when implemented they will represent a major step towards achieving a combined child health service. The next hurdle is the problem inherent in services located in two or more separate trusts in hospitals and the community. Then, when a combined child health service has been achieved, the interface with primary care can be addressed-an issue already explored in a stimulating study by the consortium Caring for Children in the Health Services.6 KLDODD Consultant paediatrician Derbyshire Children's Hospital, North Street, Derby DEl 3BA