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Facing the Future Audit RCPCH 2017

This audit reports UK performance on the RCPCH Facing the Future: Standards for acute general paediatric services and Facing the Future: Together for child health standards in June 2017. Surveys were sent to 161 paediatric clinical directors in June 2017, garnering a 70% response. Each standard is presented with a headline result and accompanying graph with commentary distilled from the undertaking of site visits across the UK. Audit of Standard 9, relevant to our GI practice in Wessex refers to Specialist paediatricians being available for immediate telephone advice for acute problems for all specialities and for all paediatricians. https://www.rcpch.ac.uk/resources/facing-future-standards-paediatric-care (The excerpt below is copied from the RCPCH report, page 39)

Facing the Future Audit. RCPCH 2018Averaged across the eight specialties, 75.4% of units have access to specialist
paediatricians for immediate telephone advice.

Access to specialist paediatric advice is crucial to enable general paediatricians to appropriately and effectively manage the care of children with specialist needs.

The RCPCH Medical Workforce Census 2015 has shown us that in Scotland, 71% of subspecialty services deliver planned work as part of a funded managed clinical network system1. During site visits, it became apparent that there is a more integrated approach to healthcare services in Scotland as opposed to the other nations. For example, Crosshouse Hospital (Kilmarnock) accessed specialist advice through a Regional Centre in Glasgow. As part of the managed network, the sub-specialties visit hospitals in the area to provide joint clinics, ensuring specialist paediatricians are known and visible. The process has improved the education of general paediatricians, making them more capable to respond to specialist queries as patients present. The network management requires District General Hospitals (DGHs) to provide feedback on where children are receiving their care, to ensure pathways are appropriate, which has enabled children to receive specialist care locally. 

Data revealed that access to specialist advice has worsened since the previous audit of the standards in 2013. This reflects variations in funding arrangements for the development of specialist services. Most units receive access to specialist advice and opinion through local tertiary centres. These links can be fragmented and informal, relying on personal, individual connections which are hard to sustain on a 24 hour, seven days a week basis. As a result, getting immediate advice can be challenging for general paediatricians that can result in delays for patient care.

Some units suggested that more work was needed to be done with specialist paediatricians to develop networked pathways of care. RCPCH recommends that generalists should work together with specialist paediatricians to foster relationships. Units who currently work through informal networks can work towards formalising these links.

RCPCH recommends that the development of formal networks between general and specialist paediatrics should be adequately funded by commissioners and service planners. The benefits of implementing standard 9 improves the level of care provided for patients and increases likelihood of compliance with other Together for child health standards. Guidance from Bringing Networks to Life and the RCPCH and BSPGHAN Quality Standards document are useful tools to drive quality improvement25,26.

 

Practice Example
University Hospital Southampton NHS Foundation Trust

The Wessex Paediatric Gastroenterology, Hepatology & Nutrition Network (WESPGHAN) provides an effective means of exchange of information that shares best practice and promotion of regional audits whilst providing continual development of services and care across Wessex. Since it was established in 2005, the Wessex network has grown to a membership of 13 hospitals including: Portsmouth, Chichester, Poole, Dorchester, Winchester, Basingstoke, Salisbury, Frimley Park, Isle of Wight, Guernsey, Jersey, Guildford and Southampton.

The Southampton paediatric gastroenterology (GI) team provides immediate telephone advice for acute problems pertaining to gastroenterology, hepatology and nutrition to paediatricians in the region, available 24 hours a day, 365 days a year. Acutely unwell children presenting with GI problems can be transferred seven days a week to be reviewed by the paediatric GI team in Southampton.

The 24/ 7 provision of immediate telephone advice has helped reduce delays in care meaning clinical issues are addressed quickly patient experience is improved. General paediatricians feel supported and reassured in their decision-making when they can easily access advice and guidance.

Alongside provision of acute services, Southampton paediatric GI team also provides visiting regional clinics in 7 regional hospitals (every 2-6 months). Each unit within the network, has a nominated lead (consultant with paediatric GI interest), providing a streamlined, direct and effective communication channel. This enables smooth delivery of care. Southampton has developed links with adult GI units from hospitals within the WESPGHAN network to improve transition pathways for young people.

WESPGHAN maintains a steady stream of communication between members of the network via their online website and forum. Members can readily access written support and advice for any queries including condition-specific care pathways, research, reports, educational resources and events are shared regularly. WESPGHAN members meet on an annual basis to discuss the needs of children and families within the region and any arising issues are dealt with collaboratively.

View the WESPGHAN website: https:/ / www.networks.nhs.uk/ nhs-networks/ wessexpaediatric-gastroenterology-hepatology

 

If you wish to read the full RCPCH report on FACING THE FUTURE Audit, please visit

https://www.rcpch.ac.uk/resources/facing-future-standards-paediatric-care

(Standard 9 is on page 39)