G50(P)\u2005‘Together clinics’: joint integrated clinic between a paediatric consultant and GP in primary care – impact on paediatric care

Abstract

Aim To evaluate outcomes and impact of a novel Paediatric ‘Together Clinic’ (TC) in Primary Care and to improve management of paediatric problems in primary care Methods Fortnightly joint clinics, run by a Paediatric Consultant and GP, in one general practice were started in September 2017 in a London borough. Children registered with the GP practice were seen for semi-urgent Paediatric input in face to face consultations or discussed in a multi professional meeting prior to clinic. Results Activity: Between September 2017 and January 2018 nine clinics were held (43 patients seen, one patient twice): 68% aged 0–5 years, 21% aged 6–10 years and 11% >10 years Presentation: 48% had a gastroenterological, 12% respiratory, 12% headaches/syncope, 7% musculoskeletal, 21% other problems. Key outcomes: Referral time to see a Paediatrician was reduced by 2 months; 50% less referrals were made to hospital outpatient clinics by the GPs; over 90% of patients were followed up by GP alone. GP feedback: Very high satisfaction expressed (70% extremely and 30% very satisfied); shared learning and improved confidence were reported (100%) with ongoing support of TC clinics (100%). Patient and family feedback: 86% reported preference for TCs, 67% reported more confidence in their GP; 100% extremely likely or likely to recommend TC; 100% patients and families felt listened to. Ongoing improvement changes: Initial Paediatric triage was changed to direct referrals by GP’s into TC; single document by GP and Paediatrician created at time of consultation with no need for clinic letters; appointment slots created for case–based discussions. Next steps: Expand and form a local GP hub and spoke practice model together with development of a IT infrastructure. Ongoing development of continuous data analysis and standard operational procedure. Conclusion Together clinics are successful in achieving improved flow and management of Paediatric problems in Primary Care. In addition inter-professional learning is gained and patient and family experience is improved. The model is cost neutral for commissioners and providers. The next steps are to form local GP hubs feeding into TC and to expand the model to other areas of the CCG.