Integrating acute services for children and young people across primary and secondary care

We wish to share our service response to the COVID-19 pandemic on the health of the local paediatric population. In North-West London we have seen a significant reduction in the numbers of children accessing paediatric services, which risks jeopardising their non-COVID-19 related health.

 

Similarly, our general practitioner colleagues have been facing challenges, moving from face-to-face interactions to largely virtual ones and we considered how we might work more collaboratively to optimise paediatric outcomes during this period. The article on integrating acute services for children and young people (CYP) across primary and secondary care published in the March BJGP issue on Child Health similarly discusses this relationship being instrumental in improving overall outcomes.¹

 

We developed an integrated service providing paediatric primary care advice by paediatric registrars and consultants, with a Monday-Friday direct telephone line and an email (48-hour turnaround for advice). This launched at the start of April 2020, advertised to GPs via our local Care Commissioning Groups and Sustainability and Transformation Partnership. We have recently evaluated the use of this service over 3 months throughout the COVID-19 outbreak, and we share some of our observations here.

 

We received a total of 288 queries from GPs by phone and email, most commonly about gastroenterology (14.2%) and dermatology (10.8%) conditions; the latter particularly by email with photo attachments.

 

After discussion with the advice line, outcomes included phone/email advice, paediatric outpatient follow up or further GP assessment. 62 (21.5%) children had an outcome of attendance to the emergency department (ED); of these 40 (65%) attended as advised and 12 (19%) did not, highlighting parents’ hesitation in attending hospital recently. Interestingly, the remaining 10 (16%) attended ED against advice given. Of those who attended ED, almost one quarter (24%) were diagnosed with a respiratory tract infection or an ear/nose/throat infection and these both typically require a face-to-face assessment, which GPs were often not able to provide at this time.

 

This initiative has received overwhelmingly positive feedback from paediatric registrars and GPs, praising ease of access at a time of mainly virtual consultations, and we will continue this service in the COVID-19 recovery period.

 

1. Patel S, Hodgkinson T, Fowler R, Pryde K, Ward R. Integrating acute services for children and young people across primary and secondary care. Br J Gen Pract 2020;70(693):158-159. doi:10.3399/bjgp20X708917.