Many NHS doctors and nurses are inadequately prepared to spot and act upon signs of child abuse or neglect, a damning report on the aftermath of the Baby P scandal warns.

The detailed survey by the Care Quality Commission exposes a failure inside the health service even among some paediatric specialists and GPs to get to grips with the challenges of safeguarding children.

It says many clinicians have not received up-to-date mandatory training in child protection, while health visitors are overwhelmed by excessive case loads.

The review was ordered after it emerged that NHS staff in Haringey, north London, including some employed by Great Ormond Street children’s hospital, saw Baby Peter, as he is now known, on 35 separate occasions in his short life and, on all but one occasion, failed to realise he was in danger.

Highlighting the inadequate response by health trusts, Cynthia Bower, the commission’s chief executive, said: “Immediately after the Baby P tragedy, everyone agreed that everything possible must be done to prevent a recurrence. This must not prove to be hollow rhetoric. The NHS has got to play its part by getting these safeguarding measures in place.

“It is clear that safeguarding has not been as high on the agenda of trust boards as it should have been … In some cases NHS staff have not been given the support they need in terms of training and clear procedures for handling concerns. If that were to change, it would be an appropriate legacy for Baby Peter.”

The 17-month-old Baby Peter, who had been also monitored by social workers and police, was seen by a consultant paediatrician, Sabah Al-Zayyat, two days before he died in Haringey in early 2007. She had not been not given the full picture of Peter’s history before the examination, although a subsequent internal Great Ormond Street inquiry said she should have identified his injuries as signs of abuse.

After he died, Peter was found to have serious injuries including a broken back and fractured ribs. His mother, her boyfriend and a lodger were later sentenced for causing or allowing the child’s death.

The report says that only 54% of eligible NHS staff have received basic child protection training, a “worryingly low” proportion. According to the inspectors, in 20 of the primary care trusts surveyed, as few as 10% of GPs were up-to-date with what was said to be a “basic” level of training.

On health visitors, the investigation discovered that 29 out of 152 primary care trusts were dealing with caseloads of more than 500 children each, “well above [the] recommendation of 400″.

Among other findings were that only 37% of trusts have a dedicated budget for training staff in child protection issues, while 65% of GPs either do not have appropriate training or there is no data to say whether they do or don’t. Only 58% of A&E or urgent care staff have adequate training in child protection.

Last year about one in 10 GP consultations were with children aged 14 or under; nearly three million children under 16 attend A&E departments ever year.

In 2008-09, the year that the Baby P scandal erupted, more NHS trusts did admit that they could not comply with national core standards – one of which deals with child protection. The numbers declaring compliance fell marginally from nearly 97% to 94% – suggesting a slight increase in self-criticism.

More than one in 10 trusts “did not appear to comply with the statutory requirement to carry out criminal records bureau checks for all staffemployed since 2002,” the report said. “We are particularly concerned with the large proportion of trusts that do not have a process for following up children who miss outpatient appointments.”

Commenting on the findings, Jo Webber, deputy director of policy at the NHS Confederation, said: “Despite the progress many NHS organisations have made, and the commitment of individuals working in the health service, there is clearly much more that can be done to make sure children are protected properly. This means promoting a culture of questioning amongst staff.”

The Liberal Democrat health spokesman, Norman Lamb, said: “It’s disgraceful that some parts of the NHS are still failing to comply with basic child protection requirements like carrying out criminal record checks on staff.”

The health secretary, Andy Burnham, said: “I want trusts and PCTs to use this report to support a coordinated programme of action to assure and sustain essential levels of safeguarding in activities relating to children.”