Summary

Developing paediatric capabilities of GPs and other healthcare professionals facilitates more healthcare delivery in community setting; "Whole-population approach" also addresses difficulties patients have in obtaining a GP appointment, as well as promoting self-care where appropriate; Attendance at A&E in relevant areas has declined, and patients feel more satisfied with care delivery in a community, as opposed to hospital, setting.

Description of practice

The problem

For most children, the GP is their main point of contact with the health service. While children make up nearly one-fifth of the population in England, they are estimated to account for two-fifths of a typical GP’s workload. Despite this, the Royal College of Paediatrics and Child Health estimate that in many parts of the country, between 40 and 50 per cent of GPs have had little or no formal paediatric training). This leaves many GPs without the skills and confidence to assess and treat children in their surgery, leading many to refer children to hospital for conditions such as fever, asthma or constipation that could be managed in primary care. The number of children admitted to hospital and presenting at A&E is rising. Evidence suggests that many of these cases could be managed outside an acute setting.

The solution

The Imperial child health general practice hubs comprise groups of two or three general practices within inner London, who work with paediatric consultants from St Mary's hospital. The hubs have three components: 

• Specialist outreach: paediatric consultants regularly attend team meetings with primary care practices, to discuss cases, and provide professioanl devlopment. 
  
  
• Open access: practices provide patients with same-day access to advice from a GP or senior nurse, and a same-day appointment if necessary. GPs also have acces to specialist advice via email and telephone hotlines.
  
  
• Patient and public engagement: engaging information initiatives designed to inform patients about appropriate use of services.

The referral pathway has also been redesigned, so that GPs discuss the most appropriate approach with a consultant before making a referral.

Implementation of practice

What stage is the practice currently in?

Ongoing

Who was/is responsible for the implementation of the practice?

The general practice child health hubs are part of the broader Connecting Care for Children programme that runs across West London, Central London and Hammersmith and Fulham CCGs. Two pilot hubs have been operating in West London CCG since early 2014, and two additional hubs began operating in Central London and Hammersmith and Fulham CCG in September 2014.

Key actors include:

• Hospital consultants and general practitioners, who drove forward the development of the hubs after years of relationship-building, and created a receptive environment.
• A children's commissioner, who held a joint post in the Primary Care Trust and local municipality.
• Staff at CCG take an active lead in spreading the model across their locality.

Hubs are paid for via a patchwork of funding arrangements.

Impact

• Hubs are expected to break even after two years, and could generate savings in the long term.
• The overall number of referrals to hospital is expected to decrease
• Waiting times in outreach clinic are shorter than in the hospital-based services
• Asthma emergency admissions in the relevant area have declined.

Additional information

The enclosed report belongs to The King’s Fund under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 licence.

Contact information

Name:

Mando Watson

Organization:

Imperial College Healthcare NHS Trust

Email:

mando.watson@nhs.net

Phone:

Role:

Health care provider

Add your comment