“Learning Together” Jointly run integrated Child Health

clinics in primary care

Chloe Macaulay, John Spicer, Bob KlaberPEDSIG November 2013

The problem

• Acute care– Increasing ED attendances – Increasing admission rates

• Secondary care referrals– 30-50% OPD referrals not “right person, right

place, right time”

• Care for chronic conditions– Less good than European counterparts

The problem

• Acute care– Increasing ED attendances – Increasing admission rates

• Secondary care referrals– 30-50% OPD referrals not “right person, right

place, right time”

• Care for chronic conditions– Less good than European counterparts

FINANCIAL PRESSURES

£££SAVING

Training status quo• GPs

– 40% GPs have no dedicated child health training– Current training: very hospital-focussed– And yet…children make up 25-40% of GP

workload

• RCGP : ST4 training with Paediatrics but no £

• CMO report Recommendation –

more Child health training

Training status quo

• Paediatricians– Almost exclusively trained in hospital

setting– Recent survey –

• > 50% would like out of hospital training • more clinic opportunities

• Increasingly will be asked to work in a different way

“Learning together” clinics in child health: education and service

The practicalities

• Last year 5 pilot sites - Camden, Haringey, Brent• Joint supervision by GP trainer and Consultant

Paediatrician

• Mix of patients• Acute• Secondary referral• Long term conditions

• Notes/responsibility “held” within General Practice

Evaluation – positive so far…

• Trainee ( and trainer) experience• Learning diaries• Focus group discussion and feedback

• Patient experience• Questionnaires

• Process measures• DNA rates• Referral rates

Learning themes

• Clinical knowledge and skills

• Communication and consultation skills

• Organisational– Understanding different perspectives– Understanding local services and

pathways

• Collaborative working– Relationship building

Further developments

• UCLP project money from HEE NCEL – full evaluation• All UCLP London areas invited to join• Currently 21 sites/practices involved

• BCF• NMH• Whittington• Homerton• UCLH• Whipps• Newham• RLH

Evaluation June 2013…

…watch this space

References

Kennedy I. Getting it right for children and young people: Overcoming cultural barriers in the NHS so as to meet their needs. Department of Health (2010)  Healthcare Commission. Improving services for children in hospital. 2007.

Milne C, Forrest L, Charles T. Learning from analysis of general practitioner referrals to a general paediatric department. RCPCH abstracts. Arch Dis Child 2010;95(suppl I):A71.  RCPCH Facing the Future: A Review of Paediatric Services (2011) Saxena S, Bottle A, Gilbert R, Sharland M. Increasing short-stay emergency hospital admissions among children in England; trend trends analysis. PLoS ONE 2009;4:e7484. Wolfe I, Cass H, Thompson M et al. BMJ 2011; 342:d1277

CMO Report 2013 Prevention pays – our children deserve betterhttps://www.gov.uk/government/news/chief-medical-officer-prevention-pays-our-children-deserve-better