National: London Borough of Hillingdon, United Kingdom

Geography type: Urban

Population covered: 78,000 CYP population (0-19-year olds), 26.3% of total population.

Professional group/type of organisation involved e.g. acute, CAMHS, voluntary sector, primary care

GPs and secondary care paediatricians and specialist nurses at Hillingdon Primary Care Confederation and Hillingdon Hospitals NHS Trust.

Details of initiative

Paediatric Integrated Community Clinics (PICCs) were developed following an increase in the number of referrals from a Hillingdon GP for a first outpatient appointment at Hillingdon Hospital from 8,654 in 2014-15 to 10,022 in 2015-16. Right Care data 2016/17 for Hillingdon CCG suggests opportunities for quality improvements in A&E attendance and emergency admission rates for children under 5 years.

Aims of service:

• To improve the quality and clinical effectiveness of Primary care for CYP through education, training and clinical support provided by paediatricians to GP’s and other primary care staff
• To develop an integrated model of care with the physical and emotional needs of CYP managed in a holistic and collaborative manner
• To provide and coordinate Multi-Disciplinary Team (MDT) meetings for education and training with relevant others e.g. from health, Children’s Centres, child and adolescent mental health services (CAMHS), education / schools, social care, voluntary sector
• To support the development of “hubs” of clinical care, which can be built on (e.g. to incorporate children’s emotional well-being and mental health services, Child Development Centre).

Objectives of the service:

• To establish PICCs in the north, south and middle of the borough
• To reduce the number of secondary care out-patients appointments for CYP
• To support GPs to manage CYP in the community / out of hospital
• To provide care that is easily accessible for CYP and families
• To support and empower CYP and families to develop self-care and resilience
• To facilitate collaborative MDT working and provision of common training via MDT seminar

Service description

The PICCs will provide joint consultations with a GP and hospital consultant paediatrician in a General Practice setting. A weekly clinic will be provided in the north, south and middle of the borough offering joint consultations with a GP and hospital paediatrician for CYP. Referrals will be triaged by the consultant paediatrician to determine suitability for management in a primary care setting.

Each clinic runs over approximately 4 hours and will have capacity for 9 appointments. Where the consultant paediatrician requests a longer slot for a patient the overall clinic capacity may be altered on that occasion. The location of the clinic will rotate within each network to ensure equity of access and facilitate maximum impact.

Care Pathway:

• Referrals are made on a standardised referral form and emailed via NHS net to thh.nhs.uk
• Consent must be obtained and an explanation as to how the PICC works given to the family / carers and CYP (age appropriate) by the referring GP
• The paediatric consultant will triage all referrals to determine if the case is suitable for a PICC or requires hospital management
• The PICC host GP will see CYP from other GP practices within the network
• The referring GP will be responsible for communicating with the host GP by electronic referral
• The referring GP may already have communicated with the consultant paediatrician via email or telephone for clinical advice
• The PICC project manager will coordinate appointments and communicate with families / carers / CYP, ensuring they are clear where their appointment will take place; it is expected that this will include communicating via phone, text and email
• Translators will be arranged as per the current operational procedures for translations & interpretation
• Clinical notes from the PICC consultation will be recorded on the child’s EMIS record and accessible by the child’s GP who will take over clinical responsibility
• The child’s GP can contact the consultant paediatrician or lead GP for further information or advice
• For MDT case discussion training events, the clinician taking the case is responsible for recording on EMIS or the appropriate electronic system, the advice and actions required
• Where CYP / families are present and taking part in the MDT, records will be recorded via EMIS
• All information will be shared maintaining governance & local and national policy, ensuring families / carers and CYP are informed appropriately
• Information will be shared with the family / carers / CYP in an age appropriate and accessible way e.g. recorded in Parent Held Record Book.

Multi-disciplinary Team (MDT) education forum

A MDT education forum will run each month led by the consultant paediatrician alongside the lead GP for each respective clinic. The session will be available by webinar to the wider MDT workforce and common teaching themes will be agreed and advertised in advance.

For specific case discussions, the GP and consultant paediatrician leading the PICC will ensure that the referring GP (who the child is registered with) is informed of and provides the on-going care and prescribing as recorded on EMIS (skilling up the child’s GP who retains responsibility for ongoing care).

Type of integration (vertical, horizontal, population)

Vertical – primary and secondary care.

Outcomes achieved

Pilot results:

From January 2017 to February 2018 a total of 431 CYP were seen in PICC, the highest proportion being under 2 years. Clinics were held in 7 out of the 15 practices that make up Clover Health network.

Challenges, successes, lessons learned and advice

The clinics proved very popular with families appreciating the opportunity to see a GP and consultant at the same time and also welcomed the convenience of having the consultation in the GP practice setting.

The five top reasons for referral to the PICCs in 2017/18 were: Eczema, Cow’s milk protein or food intolerance, weak/poor growth or frequent infections, constipation and unspecified parental concern.

Cost benefit information

Not provided.

Website links

Integrated Paediatric Community Clinics

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