Our local children’s services offer real evidence that integrated care models can help solve NHS challenges
To provide high quality and safe care we must work closely with our patients, their families and our partners – primary, secondary and community healthcare providers – in order to navigate and overcome challenges faced in a hospital which is running at almost full capacity. Consultant general paediatrician, Dr Bob Klaber, who has a decade of experience in integrated child health, explains how he and his team are helping to change the way Imperial College Healthcare works within the community.
Perhaps the most striking aspect of the first two episodes of the BBC2 documentary #hospital has been how the amazing staff, patients and families work so closely together, and with such courage and kindness, to navigate the challenges of a hospital that is almost completely full.
The series has shown how the Trust is using energy, expertise and resource to manage an ever-changing list of priorities and to continue to improve services. However, it’s important to highlight that our work does not end there. We are also designing and implementing new approaches that enable us to provide more care outside of hospital. This work is growing in ambition and reach and includes new community services in many specialties, including women’s health, cardiology, and respiratory medicine.
Although children tend not to get stuck on medical wards long after they are medically fit to be discharged, paediatric services have been leading the way in transforming care to provide much more of it outside hospital. This includes a new integrated care programme called Connecting Care for Children delivered in partnership with GP practices.
The model includes a network of child health GP hubs across north west London, where our consultant paediatricians come together with small groups of GP practices, as well as health visitors, dieticians, social workers, mental health workers and students and trainees from a wide range of disciplines every four to six weeks. A multi-disciplinary team (MDT) meeting is held each time. The group talks through the care of 10-15 patients. These meetings enable genuinely integrated approaches to be developed, so that children and their families get the care and support they need, when and where it is best for them. A broad mix of expertise helps us to widen our discussions, strengthen the building of relationships and create a culture of learning.
MDT meetings are allowing consultant paediatricians, whose work is traditionally built around seeing the ‘next patient’, to support the GPs in looking after the population of patients they serve, and to bring their insights and specialist experience into more proactive, prevention-focused discussions.
In addition to the MDT meetings, our consultant paediatricians run joint outreach clinics alongside GPs from each of the practices. This time spent together is invaluable. In most cases GPs no longer need to refer patients to hospital – instead they can talk through a patient’s care during the clinic, and subsequently the patient can be treated locally. This benefits the patient and their family. They no longer need to wait up to 12 weeks for a hospital outpatient appointment – they can be seen, diagnosed and treated in less than six weeks in a familiar community setting. We can see that by working more closely with our patients and their families, they too have more confidence in primary and community care, and what it can offer.
Another thread of the programme is our consultant telephone and email advice hotline, which provides on-going support. The hotline can be used by GPs and other community-based professionals when they require advice. The hotline is widely used and builds on the face-to-face connections that have been made.
When we first started Connecting Care for Children we knew that we wanted to work with children, young people and their families to co-design and develop a new model of care. We did just that, and since then we have successfully recruited volunteers who work as Practice Champions at their local GP practice. These are young people, parents and members of the local community who voluntarily give their time to offer peer-support and to help meet the health needs of patients and the wider community.
The Connecting Care for Children programme has demonstrated that much of the hospital’s traditional outpatient care, and some of the more straightforward emergency care, can be delivered in a more connected way within the GP Hubs. For example, in one of the hubs that we have formally evaluated, 39% of hospital appointments for new referrals were avoided altogether and a further 42% of appointments were moved from hospital to joint clinics we run in the GP practice. In addition, there was a decrease in specialist referrals, admissions to hospital and children attending accident and emergency. Families who we have worked with have said that they preferred appointments at the GP practice and that after this experience they now felt more confident about taking their child to their GP in the future.
We feel that much of our learning from establishing Connecting Care for Children is applicable to adult health care too. Reflecting on our experiences over the last few years the following points jump out as being particularly important:
- Focus more than anything on developing strong connections and relationships between different parts of the health service.
- Put GP practices at the heart of care - specialist services can then be drawn out of the hospital to provide support and to help connect services across all of health and social care.
- Specialist doctors and GPs need to support one another to improve whole population health, reviewing patients on their registered list is an important way to facilitate greater focus on prevention.
- Recognise that, as well as seeking specialist advice from professionals, we all lean on friends and family for important support and advice around healthcare issues.
- Programmes such as the Practice Champions are important ways of providing support to this reality.
- Establish strong partnerships with patients, carers and communities to work together to co-design new approaches to care.
- Aim to achieve outcomes that our patients tell us are the ones that really matter to them.
- Don’t forget about the workforce; developing a culture of learning across a multi-professional team is a key way to improve care.
We are continuing to work with colleagues and communities across north west London to move this work forward at pace. A significant and sustainable impact on the challenges highlighted in #hospital will only be achieved by developing new models of care, including ones that are more rooted in the community. We really hope that the story of Connecting Care for Children, and many others alongside it, will be ones that continue to grow.