Facing the Future - standards for acute general paediatric services

It is essential that paediatrics is a 24 hours a day, seven days a week specialty, with the most experienced doctors present at the busiest times. Our report sets out ten standards for high quality, safe and sustainable acute general paediatric services.

We believe that these standards will bring a level of consistency to what is currently quite a variable pattern of practice.

The intention is to ensure that every child is seen in a timely manner by a suitably experienced doctor.

About the update

In 2010, we first published the Facing the Future standards, setting out ten key requirements to deliver high quality, safe and sustainable acute general paediatric services.

The Back to Facing the Future audit in 2013 demonstrated that the standards are being used on a daily basis by paediatricians, both to reflect on their own practice, and to advocate for better care for children. It was always intended that Facing the Future would remain live and flexible to changes in the health system and, five years on from their original publication, the RCPCH has conducted a review of the standards and agreed to amend four of them.


  • A consultant paediatrician* is present and readily available in the hospital during times of peak activity, seven days a week.
  • Every child who is admitted to a paediatric department with an acute medical problem is seen by a healthcare professional with the appropriate competencies to work on the tier two (middle grade) paediatric rota within four hours of admission.
  • Every child who is admitted to a paediatric department with an acute medical problem is seen by a consultant paediatrician* within 14 hours of admission, with more immediate review as required according to illness severity or if a member staff is concerned.
  • At least two medical handovers every 24 hours are led by a consultant paediatrician* .
  • Every child with an acute medical problem who is referred for a paediatric opinion is seen by, or has their case discussed with, a clinician with the necessary skills and competencies before they are discharged. This could be: a paediatrician on the consultant rota, a paediatrician on the tier two (middle grade) rota, or a registered children’s nurse who has completed a recognised advanced children’s nurse practitioner programme and is an advanced children’s nurse practitioner.
  • Throughout all the hours they are open, paediatric assessment units have access to the opinion of a consultant paediatrician* .
  • All general paediatric inpatient units adopt an attending consultant* system, most often in the form of the ‘consultant of the week’ system.
  • All general paediatric training rotas are made up of at least ten whole time equivalent posts, all of which are compliant with the UK Working Time Regulations and European Working Time Directive.
  • Specialist paediatricians are available for immediate telephone advice for acute problems for all specialties, and for all paediatricians.
  • All children, children’s social care, police and health teams have access to a paediatrician with child protection experience and skills (of at least level 3 safeguarding competencies) who is available to provide immediate advice and subsequent assessment, if necessary, for children under 18 years of age where there are child protection concerns. The requirement is for advice, clinical assessment and the timely provision of an appropriate medical opinion, supported by a written report.

Implementing the standards

The implementation plan provides tools and resources to support clinicians, service planners and commissioners to meet standards. These aim to equip you with the necessary practice examples and workforce recommendations that will help local services meet the standards. We make five key recommendations:

  • Reduce the number of inpatient sites
  • Increase the number of consultants
  • Expand significantly the number of registered children's nurses
  • Expand the number of GPs trained in paediatrics
  • Decrease the number of paediatric trainees.
  • * a b c d e Or equivalent staff, associate specialist or speciality doctor who is trained and assessed as competent to work on the paediatric consultant rota