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Objective-To assess the workload of, and referral patterns to, paediatric cardiology outreach clinics to provide data for future planning. Design-Descriptive study of outpatient attendance during 1991 and 1996. Setting-Five district general hospitals with unchanged local demographics and referral patterns during the study period. Methods-Postal, telephone, and on site survey of clinic records and case notes. Results-The number of outpatients increased by 61%, with a consequent increase in the number of clinics held and patients seen in each clinic. The number of patients aged between 10 and 15 years doubled. Conclusion-These data confirm the impression that demands for paediatric cardiology services are increasing. The increased need for attendance at outreach clinics has inevitable consequences for the clinical, teaching, and research activities of specialists in tertiary centres. An increase in the number of paediatric cardiologists, or development of local expertise (general paediatricians with an interest in cardiology), will be required. Furthermore, the increasingly large cohort of older teenagers and young adults with congenital heart disease underscores the need for the development of specialist facilities. (Heart 1998;79:223-224) Keywords: paediatric clinics; workload; congenital heart disease Outreach clinics (specialist paediatric cardiology clinics conducted with paediatricians in local hospitals) are an important part of the workload of the paediatric cardiologist. Patients and families attending a local specialist clinic have less travelling and perhaps better continuity of care. These clinics provide the cardiologist with an opportunity to educate staV, improve local care, and, in the age of purchaser provider health care system, maintain loyalties and possibly increase patient referrals. There are some disadvantages however: local facilities are not always ideal, and as the clinic is usually consultant led, availability for teaching, training, and service commitments is reduced at the tertiary centre. An increase in outreach clinic workload will therefore have wide reaching implications for paediatric cardiology services.The general impression is that workload in paediatric cardiology is increasing. Our recent review of an open access echocardiography clinic held in a special centre showed a large increase in workload over a five year period; the number of patients increased by 51%.This study aimed at measuring the changes in numbers and demographics of patients attending outreach clinics during a similar five year period. Materials and methodsThe three consultants at the Royal Brompton Hospital attend clinics in over 30 diVerent referring hospitals, on average four times per year. Patient attendance at each clinic during 1991 and 1996 in five referring hospitals was analysed. These clinics were chosen because each had well established clinics serving large regional populations, each was conducted by the same local consultant(s), each had unchanged tertiary referral commitments, and da...