Faced with staff shortages and a recognition that the core health surveillance system in schools could not be sustained, school nurses in one area decided to pool their skills and target surveillance to children with identified needs. Following completion of a pilot programme in October 2002, the school health nursing service has been restructured and now operates in teams who manage a corporate caseload. The core programme includes a targeted health surveillance programme, a programme of health promotion and a referral system that were modelled on the pilot project.