AN INTER-DISTRICT AUDIT OF THE SCHOOL ENTRY MEDICAL-EXAMINATION IN CHESHIRE

An inter-district audit was carried out on the benefit to children of universal school entry medical examination, the appropriate use of pro fessional time and to establish a baseline against which to measure fu ture changes in services to under-fives and schoolchildren. The school health records of 1127 Cheshire schoolchildren, a random 10% sample, were scrutinised. There were significant district variations. Overall, 45% of children had problems not previously noted: 21% were serious e nough to be referred; 11% could have had their problems managed by a w ell-trained school nurse but 9.8% would have required a medical examin ation for detection and assessment. These included conditions such as undescended testes, heart murmurs, squints and hernias and 8% required immediate action. The selection criteria, based on the absence of a t hree-year health check and/or parental or nurse concern, would have fa iled to identify 217 of the 491 children with new problems, some of wh ich were serious. Targeting only an area of high deprivation or poor h ealth would equally miss significant conditions. The inter-district va riation of the numbers and diagnoses of new problems detected at schoo l entry, and the difficulty in predicting which children will have imp ortant conditions, provide a good case for the continuation of the sch ool entry medical examination for all children.