Any of these Trusts may employ the staff - consultant paediatricians, consultant community paediatricians, clinical medical officers (many of whom are school doctors) from whom the DHA will need to designate a medical officer for special educational needs.

2:44.   The role of the general practitioner will largely depend on whether he or she has provided the medical input to the programme of pre-school child health surveillance which is delivered at child health clinics and, increasingly, within GP practices.  A GP who has accepted a child for child health surveillance will be best equipped to provide an initial medical report for children up to age five.  Elsewhere clinical medical officers, who usually work in clinics and in the school health service, and health visitors and school nurses may be capable of providing fuller information.

2:45.   With the introduction of the contractual arrangements for the purchase and provision of health services referred to at paragraph 2:43, the designated medical officer for special educational needs will have a strategic and operational role in coordinating activity across DHAs, NHS Trusts and GP fund holders.

2:46.   At the strategic level, the designated medical officer should check that the DHA have arrangements for ensuring that the Trusts and GPs providing child health services:

inform LEAs of children who they think may have special educational needs (paragraph 5:13)

provide medical advice to LEAs for the assessment of children within the prescribed time limits (paragraphs 3:33 and 3.34)

consider, with LEAs and with regard to available resources, the health services' contribution to the non-educational provision to be specified in a statement (paragraph 4:32)

2:47.   At the operational level, the designated medical officer should:

ensure that all schools have a contact (usually the school doctor) for seeking medical advice on children who may have special educational needs

provide a resource to other health service staff - for example, GPs and therapists - who require assistance in preparing reports on the medical history and health needs of children for schools and LEAs

coordinate the health services' advice for a statutory assessment and, frequently, participate in multi-agency meetings on assessments and making statements

coordinate the provision to be made by the health services for a child with special educational needs when, as may be the case with therapy and nursing services, either a DHA or GP fund holder may be responsible for the purchasing of these services.

2:48.   Conditions such as a hearing loss or a visual impairment  may, if undiagnosed, lead to the child losing interest and becoming alienated.  Even when a child's known medical