Paediatric GPSI service in Bristol area David Capehorn Lisa Goldsworthy
Initial ideas Close working between primary care provider and hospital paediatrics Awareness of variable practice A disheartened feeling of general paediatrician when responding to OP referrals Analysis/audit of GP OP referrals to medical paediatric specialities at Bristol Royal Hospital for Children
Professional Description of Service Advisory Email access Individually tailored Clinic option (Not choose and book)
Managerial description Reduction of cost Referral management Closer to home for patients Is Clock starting relevant? Interaction with acute provider
Professional issues 40% of GPs no paediatric training Update and support of those individuals and practices who want to develop Liaison with hospital practitioners to ensure standard of care Development of Paediatric GPSI training, accreditation and appraisal
OP referral audit - 2005 Presented to GP study day One month of all paediatric referrals Dermatology, ENT, community paediatric (developmental and behavioural) appropriate. 50% of others could have been seen by GP with paediatric expertise Problem with speciality referrals
How service evolved - 2006 Tenacious discussion with S Glos PCT paediatric commissioner Appointment of two GPwSI paediatric doctors Option of GPwSI referral for first 4 years Awareness campaign by PCT to local GPs to enhance referral
Development 2010 All paediatric referrals for advice and/or appointment to come via single advice email address Increase in patients seen in clinic, big savings for PCT Some new work (but in a climate of imcreased demand); some cost saved
Numbers - Full service from Feb 2010 - Impact felt from April 2010 = 2 month opd wait
Numbers Headline figures from the pilot full service April 2010 December 2010 1200 new referrals to bch (comparison =1800 new referrals April 2009 to Dec 2009) These numbers replicated subsequently
Numbers Cost implications Secondary/Tertiary care opd 241 Follow up cost 121 New to fu ratio 1:3.6 Overall year on year south glos saving 350k
Numbers Patients in GPSI service - South glos 6250 email referrals received feb 2010 to April 2012-25% GP advised re management in primary care - 40% seen in GPSI service - 35% referred other services inc BCH
Numbers Full service well established south glos Pilot established Gloucestershire and Bristol localities Early figures 20% reduction in secondary care using advice only
Qualitative stuff Problems very few Onward referral to secondary /tertiary care smooth on average? 6-8 per year to tertiary specialists No adverse outcomes Massive positive feedback from GPs /patients questionaires being done
Additional development - managerial/service Gloucester and Bristol Advice with view to providing clinics Sort out succession planning/growth Assessment of service Liaison with local GPs and PCTs/ consortia re future arrangements
Additional Development - professional Liaison with local paediatricians Guideline development in conjunction with hospital and PCT and other GPs Accreditation, training, credibility
Unsolved areas Demonstrating that the service is appreciated by: GPs Families Hospital colleagues Standards being maintained /monitored?
Few Grumbles/ feedback One complaint One developing illness, some identified with serious conditions - but care facilitated prior to secondary/tertiary care No serious incidents How to overcome specialty protectionism
Positive feedback GP informal notes GP and PCT ongoing use of service Satisfaction expressed by families Good interaction with hospital colleagues Improved referrals and practice Training of new GPwSIs
Current Aims and Ideas for the Future Network of GPwSI paediatrics, paediatricians and practices Continued education for GPs Good communication between hospital teams and primary care Patient and family focussed