CONNECTING CARE FOR CHILDREN: A partnership between CCGs, hospital & community health providers, GP federations & networks, local authority, charity, patients, citizens and more NEL ICS 22 nd July 2020
THE PROBLEM THE OPPORTUNITY
WHY WE MUST DO BETTER……. • Reduce child health inequalities • Prioritise public health, prevention and early intervention • Build and strengthen local, cross-sector services to reflect local need
Your Population The Bush Doctors Richford Gate Medical Centre Park Medical Centre Brook Green Medical Centre North End Medical Centre Registered patients Crime Deprivation Index (top quintile) main language H&F most deprived BAME not English borough in London H&F falls in top live in quintile for Living overcrowded Environment conditions Deprivation
WILL DOING MORE OF THIS LEAD TO BETTER?
THE DESIGN
CHILD HEALTH GP HUB 3 core elements – centred in primary care • Practice Champions recruited to keep focus on the things that matter to the local community • Wide public engagement programme around health & wellbeing related learning • Close contact between MDT professionals on phone & email • Work to widen access to their GP practices for children and young people • Paediatrician leads monthly lunchtime MDT • While in the practice runs a joint clinic with rotating GP • Opportunity to use the paediatrician for any other child health related work
Child Health GP Hubs – a model of integrated child health Tertiary Care • Each hub is typically 3-6 GP Sub-specialty practices within existing locality/network in NW London Paediatrics • ~20,000 practice population (~4,000 children), but this will grow with move to PCNs • 6 hubs with 26 GP practices established Vertical integration Secondary Care between GPs and General paediatric services Paediatrics Horizontal integration across multiple agencies Health Visitors CAMHS School Nurses Voluntary sector Dieticians Schools Community Nurses Social Care Practice Nurses Children’s Centres Child Health GP Hubs
Your Children & Young People Network Health Visitors CC4C MDT School Nurses Maternity Champions Baby clinics Richford Gate CC4C MDT Charecroft Community Hall Melcombe Children’s William Morris Sixth Form (Shepherds Bush) Centre Camilla March Barbara Shelton Lucinda Heeks Champions at Baby check & Baby Specialist Paediatrics (via Health Visitor Resus (North End) School Nurse CC4C) (CLCH) (CLCH) Sara Benjamin Monthly Child Health GP Hubs Paediatrics (via CC4C) 2019 Helpforce Bob Klaber (CC4C hub GP pilot at The Schools Voluntary and consultant) Community Bush Doctors Sector CAMHS H&F team Attend CC4C hubs CYP, Emily Skipsey CAMHS (CC4C) Family Child &GP Development Services Family Support LBHF Family Support Based at Melcombe SALT Children Centre LBHF Midwife Attend CC4C hubs Public health Wendy Dormer Anita Parkin (Director of Public Health)
A Whole Population Approach: Patient Segments in Child Health Integrated care is often built around patient pathways. In stratifying children and young people we strongly advocate a ‘whole population’ approach, where broad patient ‘segments’ can be identified: • Advice & prevention eg: Breast feeding / Immunisation / Healthy Child Mental well-being / Healthy eating / Exercise / Dental health Vulnerable child with • eg: Safeguarding issues / Self-harm / Substance misuse / social needs Complex family & schooling issues / Looked after children Child with single long- • eg: Depression / Constipation / Type 2 diabetes/ Coeliac term condition Disease / Asthma / Eczema / Nephroticsyndrome • eg : Severe neurodisability / Down’s syndrome / Multiple Child with complex food allergies / Child on long-term ventilation/ Type 1 health needs diabetes Acutely mild-to- • eg: Croup / Otitis media / Tonsillitis / Uncomplicated moderately unwell child pneumonia / Prolonged neonatal jaundice Acutely severely unwell • eg: Trauma / Head injury / Surgical emergency / Meningitis / child Sepsis / Drug overdose / Extreme preterm birth Dr Bob Klaber & Dr Mando Watson Imperial College Healthcare NHS Trust
THE LOGIC BEHIND THE MODEL: Action Effect Diagram - Adapted June 2018 from CC4C/CLAHRC 2014 Mando.Watson@nhs.net ACTION EFFECT DIAGRAM M.Blair@imperial.ac.uk Bob.Klaber@nhs.net GLOBAL AIMS PRIMARY DRIVERS SECONDARY DRIVERS Grow our shared understanding of services/communities to better use existing resources Better quality of care Strengthen connections and Open Access: email and relationships between individuals, telephone connections teams and organisations Better population health Build awareness, child health Specialist Outreach: clinics capability and empowerment in staff, and multidisciplinary team patients, professionals & communities meetings Reduced per capita costs Include whole population to drive prevention & improve equity Practice Champions: patient Better staff experience and public involvement Design care that delivers outcomes that really matter to patients Use quality improvement methods to test and implement different ways of working
EVALUATION: HOW DO YOU SHOW IT WORKS?
OUTCOMES FROM CHILD HEALTH GP HUBS Improved Reduced Improved Improved staff experience of per-capita population experience & care cost health learning Outstanding Observed reductions Segmentation model GPs at heart of model feedback of patient & in hospital activity allows for specific All GP trainees, FY family experience from GP practices preventative doctors and ST1-3 involved in a hub: interventions – eg: trainees in paeds at As a result of being 39% reduction in - Focusing on all Imperial now get seen in the Child outpatients children with asthma experience of the hubs Health GP Hub 88% 22% reduction in ED having a clear action Relationships & of parents felt more 17% reduction in plan at home, school, connections are built comfortable about admissions GP & hospital through learning taking their child to - Improving the Better use of existing see their GP in the Described on many proactive resources through future occasions as “the best management of connecting care CPD I have ever had” dental health
SCALE, SPREAD & SHARING LEARNING
NORTH WEST LONDON Imperial and Hammersmith & Fulham CCG: 1 multi-practice hub, fully aligned to PCN Imperial and West London CCG: 3 multi-practice hubs Imperial and Central London CCG: 2 multi-practice hubs Evelina (GSTT) and Central London CCG: 1 multi-practice hub
EMAIL AND PHONE ADVICE Paediatrician advises: GP emails GP replies: paediatrician: - Parents to video Symptoms settle - Check BP child with abnormal Video seen at MDT and - Appt in 2 weeks at movements – next movements are no hub clinic or sooner steps? longer concerning in hospital?
NWL GP WEBINAR - feedback 20
SHIELDING FLOWCHART FOR GPs
RESOURCES
RESOURCES
COMMUNITY LINKS
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NEW CARE MODELS IN CHILDREN – DESIGN PRINCIPLES 1. New approaches to care to be co-designed with children, young people, parents, carers and communities 2. Focus on outcomes that really matter to patients 3. Focus on connections and relationships ; NHS services can be minimally changed, while their capability and capacity are maximised 4. Harness existing strengths : put GP practices at the heart of new care models - specialist services are drawn out of the hospital to provide support & to help connect services across all of health, social care and education 5. Include the whole population , (using segmentation to create bundles of care) to drive prevention and improve equity 6. Health seeking behaviours improve through peer-to-peer support 7. Use education and development , for the whole multi-professional team, as a key way to build relationships and finding new ways to work together
GETTING IN TOUCH 25 th September 2:30-4 WEBIN AR: EM AIL: mando.watson@nhs.net imperial.cc4c@nhs.net TWITTER: @CC4CLondon WEBS ITE: www.cc4c.imperial.nhs.uk WORK S HOPS : imperial.cc4c@nhs.net
EXTRA MATERIAL
USE OF HOSPITAL SERVICES Reference: Montgomery-Taylor, S., Watson, M., & Klaber, R. (2016). Child health general practice hubs: a service evaluation. Archives of disease in childhood , 101 (4), 333-337.
Child Health GP Hub Costings - Taking into account ALL costs of implementation Amount included Resource per monthly Hub within the costings Consultant time in monthly MDT 0.34 hours per week Consultant time in monthly clinic 1.72 hours per week Consultant email /phone advice 1 hour per week General Practitioners (MDT - a GP from each of 4 practices) 0.34 hours per week General Practitioners (one GP present in each monthly clinic) 1.72 hours per week Band 6 coordinator 5.36 hours per week Use of rooms / facilities £150 per month Co-production work funding £6,500 per year Training Practice Champions £10,000 Senior programme manager Set up cost only
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