A new model of care for children in Primary Care Rosalyn King Director of Health Outcomes March 2015

Why a new model of care for children? The Marmot Review (2012) states: ‘The foundation for virtually every aspect of human development – physical, intellectual and emotional – are laid in early childhood. What happens during these years (starting in the womb) has lifelong effects on many aspects of health and well-being from obesity, heart disease and mental health, to educational achievement and economic status.’ The Marmot Review (2010) Executive Summary, p 26.

GP Practice Community Matrons and District Nurses Mental Health Nurses Pharmacists Voluntary Services Paediatric Clinics Adult Social Care Environmental Health (Residential Services) Care Navigator GP Practice GP Practice GP Village team

Westminster Children and young people <20 = 19.2% of population. 86.1% of school children are from a minority ethnic group. Child poverty is worse than the England Average with 35.4% of children aged <16 living in poverty. Child obesity is worse than average 11.6% of children aged 4-5 and 25% of children aged yrs are classified as obese. Immunisations rate is worse than England average.

Referrals to hospital

A&E attendance

A new model of care for children Monthly joint GP and Consultant Paediatric clinics with 25 minute appointments to see children who would otherwise have been referred to hospital. Followed by multi professional team meetings providing a network of support and expertise for children and their parents/carers.

A Whole Population Approach: Patient Segments in Child Health Advice & prevention eg: Immunisation / Mental well- being / Healthy eating / Exercise / Dental health Healthy child eg: Safeguarding issues / Self-harm / Substance misuse / Complex family & schooling issues / Looked after children Child with social needs eg: Severe neurodisability / Down’s syndrome / Multiple food allergies / Child on long-term ventilation/ Type 1 diabetes Child with complex health needs eg: Depression / Constipation / Type 2 diabetes/ Coeliac Disease / Asthma / Eczema / Nephrotic syndrome Child with single long- term condition eg: Upper respiratory tract infection / Viral croup / Otitis media / Tonsillitis / Uncomplicated pneumonia Acutely mild-to- moderately unwell child eg: Trauma / Head injury / Surgical emergency / Meningitis / Sepsis / Drug overdose Acutely severely unwell child Integrated care is often built around patient pathways. In stratifying children and young people we strongly advocate a ‘whole population’ approach, where 6 broad patient ‘segments’ can be identified: Dr Bob Klaber & Dr Mando Watson Imperial College Healthcare NHS Trust

Benefits for children 1 Dedicated Care Co-ordination team in each Village to link patients with all the services they require. This will include social prescribing. Improved care co-ordination between care professionals including GPs, Practice Nurses, School Nurses, Health Visitors, Midwives, Dieticians, Speech and Language professionals, CAMHS, Social Services, Safeguarding teams.

Benefits for children 2 Shorter waiting times – generally < 4 weeks compared with < 12 weeks More convenient locations for patients, tailored to needs, so includes organisation of translator facilities when needed. 25 minute appointments with a GP and Paediatric Consultant both having access to the whole patient medical record. Easier transition for children when they enter adult services as a result of co-ordinated services, particularly relevant to children with disabilities.

Patient Feedback ‘I met group of doctors who listened to us and explained to us enough and we felt very confident when the appointment had finished.’ ‘very convenient, less waiting time, less risk of picking up a bug. Long appointment and not the usual rush.’ ‘its easier for me with two little kids and waiting time is really short with the GP.’ ‘its nearer, feels like less waiting time.’ ’Less of a wait, closer to home. You feel more comfortable and directly involved. Brilliant service. Thank you for seeing us.’

Any Questions?