Salford Children s Community Partnership

Transcription

1 Healthy Lndn Partnership Imprving children and yung peple s ut-f-hspital care Salfrd Children s Cmmunity Partnership Started: Phase I (prf f cncept): April 2011 June 2014; Phase II (prf f scale): July June 2016 Regin: Little Hultn (Greater Manchester) Gegraphy: Urban Estimated lcal pp years: Little Hultn ttal ppulatin (2011 Census) = 12,851 Backgrund The prject was designed as a cmmunity-based alternative fr the management f acute childhd illness in rder t address the issues f: High rates f paediatric accident and emergency attendances Significant expenditure n children s unplanned shrt-stay admissins Care quality issues with regard t children s services in primary care A lack f cmmunity-based alternatives t higher cst secndary care services that were able t keep unwell children at hme (whenever it was safe and pssible t d s) A vid in the wider NHS health ecnmy f a scalable and effective mdel f general practicebased management f acute (paediatric) hspital admissin avidance Aims The main aims f the prject were t: 1. imprve the quality f childhd acute illness management in the general practice setting; 2. decrease the children s ED and acute admissin spend. Target patient grups Infants and children frm 0-16 years f age The service mdel PHASE I (prf f cncept): Healthy Lndn Partnership Transfrming Lndn s health and care tgether 1

2 The service placed an APNP within the Little Hultn general practice site f Salfrd Health Matters in rder t prvide an expanded ffer f care fr children s acute illness management/hspital avidance (Figure 1). Fr example: A child that is wheezy, febrile and chesty is assessed, started n brnchdilatrs and bserved in the practice fr a shrt perid by the APNP. If the child s clinical respnse allws, he/she is discharged hme with fllw-up prvided int the evening hurs by the CCN with return t the Salfrd Children s Cmmunity Partnership (SCCP) in the mrning If the family/carer cntacted the surgery with a nn-acute cmplaint, the cnsultatin wuld be cnducted by the Little Hultn, general practice staff Figure 1: SCCP (Phase I) - A general practice-based mdel f an expanded ffer fr 2 cmmn acute childhd presentatins NB: If the child s initial respnse was nt satisfactry, i.e. the APNP felt the child s was nt respnding adequately, r the child s initial presentatin is deemed by the APNP t require immediate secndary care interventin, the family is sent directly t the lcal paediatric bservatin and assessment unit fr further management/evaluatin. PHASE II (prf f scale): Phase II f the prject is an expansin f the riginal service cnfiguratin as it includes children frm 4 ther general practice sites in Little Hultn; thereby creating a federated mdel f delivery, encmpassing all the lcality general practice sites. The service mdel and bjectives remain the same (i.e. imprved quality f acute childhd illness management in general practice and paediatric unplanned hspital admissin avidance). The nly changes t the mdel in Phase II are the use f a shared appintment bking system and a mre rbust inclusin and inclusin criteria fr SCCP attendance (Figure 2). Families/carers f unwell children in Phase II cntact their wn practice, which then decides whether SCCP attendance is apprpriate r nt (Figures 3 and 4). If the child des nt meet 2

3 the SCCP 2 inclusin criteria, the child is seen at their registered practice. The shared bking system is web-based, secure, and shared synchrnusly acrss all practice sites. Figure 2: SCCP Phase II: Inclusin and Exclusin Criteria 3

4 Figure 3: SCCP Phase II: Streaming Pathway Figure 4: SCCP Phase II: Care Mdel Opening times 8am -6.30pm Mnday t Friday 4

5 Staffing The clinic is led APNPs; MSc-prepared Advanced Nurse Practitiners, specialising in ambulatry care fr infants, children and yung peple Wh can refer GPs frm any ne f the 5 cllabrating practices (NB: after phne review) Wh is accuntable fr patients? The APNPs functin under the clinical gvernance f Salfrd Health Matters fr clinical care as part f the SCCP cnsultatin; as such, all treatment and management decisins utside f thse relating t the SCCP episde f care (e.g. sub-specialty cardilgy referral) remain the respnsibility f the registered practice. NB: the APNPs dcument all SCCP-delivered care (synchrnusly) in the clinical system f the practice at which the patient is registered with. Specifically, recrding f SCCP cnsultatin (and the need fr any further fllw-up) is cmmunicated electrnically t the registered practice immediately after the cnclusin f the SCCP cnsultatin. Resurces 2 x General Practice -based cnsulting rms 2 x paediatric pulse ximetry capability, autmated paediatric bld pressure machine, wide angle Welch-Allyn t-phthalmscpes 2 x Child play pens Infant and paediatric scales Child-friendly play space (receptin area) Child-friendly play space (cnsultatin rm) Basic pharmaceuticals: Large vlume spacers, salbutaml, prednislne, ibuprfen, paracetaml, dexamethasne, steri-strip, flurescein stain, sme basic dressing supplies Child friendly, infectin cntrl cmpatible tys Funding rganisatin Phase I Funding: prvided by a 3 year DH innvatin grant Phase II Funding: prvided thrugh a CCG innvatin grant Level f patient/family invlvement Exceptin service-user feedback: FFT fr SCCP Prject = 100% recmmended (March 2016) Level f integratin in the system 5

6 Ppulatin Evaluatin Safety CQC (Care Quality Cmmissin) nspectin f SCCP utstanding rating SCCP with n adverse events SCCP with n near misses SCCP with a safety culture: Safety Walk Runds APNP cmmunicatin strng team wrking Datix SE reprting transparency Effectiveness The SCCP prject was recgnised by HSJ and General Practice Awards (2013) fr excellence in children s service delivery, primary care innvatin, quality and prductivity. Patient experience Exceptin service-user feedback: FFT fr SCCP Prject = 100% recmmended (January 2016) See larger prprtin f under-fives, acutely unwell, fever, respiratry, GI (gastr-intestinal) cmplaints children a day with 1.4 APNP prviding cver Challenges, successes, lessns learned and advice 1. CYP/families have access t a high quality service, imprved access, paediatric expertise and a level f care which is ften times nly available in a hspital setting. Their feedback suggests that families will defer immediate ED access fr a high quality, child specific service in general practice with excellent/very gd access. 2. Streaming, (i.e. ensuring acutely unwell children g t the SCCP service whilst nn-acute childhd cmplaints such as behaviural issues, cnstipatin, nn-specific mild illness are managed by the wider general practice team), appears t be fundamental in maximising the specialised expertise f the SCCP and changing default ED behaviur in the cmmunity. 6

7 3. The SCCP mdel f an expanded ffer f primary care paediatrics needs t be placed within a general practice ftprint that is large enugh t maximise the efficiency f the resurce. 4. Intensive utreach is required t access thse families nt cnsidered t be early adpters f the scheme. 5. IT challenges related t the synchrnus nature f access t the clinical systems f all practices. Cntact fr mre infrmatin Neil Turtn, Chief Executive, Salfrd Health Matter CIC Neil.turtn@nhs.net Katie Barnes, Prject Develpment Lead, Kids Health Matters CIC Katie@kidshealthmatters.rg.uk