Keywords: General practice, pediatric care, mixed methods, training, rural health, primary care,

Background:

In Germany, General Practitioners (GP) substantially contribute to paediatric care, especially in rural areas where there is a shortage of paediatricians. While GPs treat children, their training in paediatrics is limited, which raises concerns about quality and sustainability.

Research questions:

How do GPs perceive their role in paediatric care? What motivates or hinders them, and what conditions are needed for effective, long-term involvement?

Method:

A mixed-methods study was conducted in Saxony. Three focus groups with 14 GPs (including trainees) explored attitudes, experiences, and barriers, complemented by group of paediatricians (n=3) and medical assistants (n=5) for triangulation. Data were analysed using MaxQDA. A parallel online survey reached 1622 GPs in Saxony (response rate: 13.2%, n=214), assessing practice characteristics, paediatric care provision, and willingness to treat children in the future.

Results:

Of those GPs (84.1%) who treat children, 87.8% do it out of necessity GPs see paediatric care as part of their generalist identity and value continuity and family-centred care. Key enablers include mandatory paediatric training during residency, interdisciplinary networks, child-friendly practice adaptations, and experience. Barriers include insufficient training, fear of missing complex diagnoses, lack of billing options, and legal restrictions on referrals. Only 41.2% of GPs not currently treating children expressed future intention to do so, compared to 71.8% of those already involved.

Conclusions:

GPs play a central role in paediatric care, particularly in underserved regions, but systemic gaps in education and support constrain their role. Current training durations fall short of international recommendations, undermining confidence and competence. The strong demand for structured training and networking opportunities.

Points for discussion:

How can collaboration between GPs and paediatricians be fostered to ensure equitable, high-quality care?

How can financial and regulatory frameworks support GPs without undermining specialist roles?

What role should formal GP-paediatrician networks and telemedicine play in rural care?