Treatment of acute pyelonephritis in children

teaches us that public anxieties about losing local access to emergency services carries more political clout than professional logic. Maybe it is time for the colleges to explore this public psychology and find a way of connecting with it. Secondly, they could give deeper and wider thought as to how "managed clinical networks" could be introduced so that local emergency units can flourish while complex emergency cases can be swiftly funnelled towards appropriate specialist centres. ccording to evidence presented by the London Ambulance Service to the Turnberg review of London in 1998, perhaps only 35% of patients arriving via 999 calls are admitted to hospital. The document acknowledges the need to encourage "a flexible approach to working by consultant colleagues in different hospitals forming a managed clinical network." This encouragement now needs to find its response at grass roots level in imaginative and practical proposals supported by these colleagues.