1. “Learning Together” Jointly run integrated Child Health clinics in primary care Chloe Macaulay, John Spicer, Bob Klaber PEDSIG November 2013

2. 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

3. 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

4. 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

5. 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

6. Family Paediatric trainee GP trainee “Learning together” clinics in child health: education and service

7. 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

8. Evaluation – positive so far… Trainee ( and trainer) experience Learning diaries Focus group discussion and feedback Patient experience Questionnaires Process measures DNA rates Referral rates

9. Learning themes Clinical knowledge and skills Communication and consultation skills Organisational –Understanding different perspectives –Understanding local services and pathways Collaborative working –Relationship building

10. 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

11. Evaluation June 2013… …watch this space

12. 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 better https://www.gov.uk/government/news/chief-medical-officer-prevention-pays-our-children- deserve-better