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One Big Front Door for children’s community health.

When families are concerned about their child's development, they currently need multiple referrals to get help. This project aims to build one route to help from a range of services.

Read comments 58
  • Winning idea
  • 2022

Meet the team


  • Paula Tyler - Parent with lived experience lead
  • Aishea Buckle - Family Participation Lead
  • Johanna Johnson - Therapy Services Manager
  • Louise Maclean - Manager, Community Paediatric Medical Services
  • Nick Le Prevost - Lead Consultant Community Paediatrician
  • Michelle Swindell - Business Support and Evaluation Lead
  • Brooke Lowry - Project coordinator
  • Kelly Pierce - Digital Lead - Children and Families Services

What is the challenge your project is going to address and how does it connect to the theme?

When a family is concerned about their child’s development, they need support from different services, including community paediatricians, community children’s nurses and therapy services. Families often experience making multiple referrals to these services and delays in care due to referrals being inappropriate and families being signposted to other services. This places children at risk of potential harm and poorer long term health outcomes.

Across the counties of Hampshire and the Isle of Wight (including Portsmouth and Southampton cities) around 1100 referrals are made per month to these services. Families have told us they experience real challenges getting timely access to support, reporting feeling they are ‘passed from pillar to post’.

The aim of this project is to establish a digitally facilitated single point of access, that is one Big Front Door, so that families only have to raise concerns about their child once, and experience more timely and streamlined care.

What does your project aim to achieve?

The aim is to co-design with families a single access point (Big Front Door) for them to use when they need support for their child. This will include digital options as determined by our families that could include  improvements in web access, virtual consultations and development of digital access through existing portals (e.g. an app for public health called Family Assist) and social media.

There are three objectives:

1. When families request support, they will get access to the right clinician, first time. This will result in a reduction in multiple referrals being made for the same child.

2. Through digital capture of requests for help, our integrated teams will be able to analyse more holistically client need and address future service improvement and commissioning priorities.

3. The Big Front Door will lead to greater levels of integrated multidisciplinary working, leading to a joined up and seamless experience of care for families.

How will the project be delivered?

Through rapid qualitative research (process mapping, experience based design) we will co-design with families and community partners (primary care, education and voluntary services) the Big Front Door. The project will follow iterative plan, do, study, act cycles of improvement over 12 months, with three workstreams:

Workstream 1: Co-produced digital information resources.

Workstream 2: Co-design of a new request for support pathway incorporating digital methods

Workstream 3: Co-design of clinical response to requests for support (triage, allocation, response methods and timing, levels of support).

Through collaborative working with other projects in the Integrated Care System this project will benefit from existing digital development investment. The project team (listed below) have capabilities to enable co-production, clinical, business, digital and evaluation functionality.

A baseline evaluation will include quantitative and qualitative analysis of referrals. Evaluation will consist of a quantitative analysis of requests for support (number of referrals, response times) as well as qualitative experiences of care.

How is your project going to share learning?

Learning will be shared with the Q community through updates on the Q website, as well as presentation at  Q events. Updates will  be shared via social media. The project lead will provide a regular more detailed update via a blog, which will be shared on the Q community website.

The project will  be shared with the wider Health System across the UK and Ireland through traditional routes (e.g. publication and presentation at meetings and conferences). Sharing will be targeted to specific networks, including those associated with child health, paediatrics and allied health networks (eg the British Association for Community Child Health).

The project will be shared with children, families and the wider network of professionals associated with children using accessible information methods and platforms identified by our experts by experience. Creative communication routes, including use of storytelling will be considered.

How you can contribute

  • We would very much appreciate Q community colleagues to act as promotors and networkers for our project, in order to gain interest in our work, and to share it widely so we are able to benefit from wider collaboration and learning.
  • We would value advice and critical support from Q community members with expertise in the following; community child health, referrals process mapping and redesign, experience based design and the use of digital functionality to support access to services.
  • We would also welcome critical friends who will feedback and guide us as we embark on but also update on the progress of our project.

Plan timeline

22 Mar 2022 March - Develop idea, form core team and submit to QExchange
27 May 2022 Co-design wider group and stakeholders
14 Jun 2022 QExchange funding announced
29 Sep 2022 July-September Experienced-based design focus groups, staff, stakeholder engagement, process mapping
28 Oct 2022 October PDSA (planning) - co-production of pathway, processes and resources
31 Jan 2023 November-January PDSA cycle one (delivery and rapid evaluation)
28 Feb 2023 February co-review and revise pathway, processes and resources
31 May 2023 March - May 2023 PDSA cycle two (delivery and rapid evaluation)
30 Jun 2023 June 23 on: Share outcomes and wider rollout


  1. Having a single point of access to the various specialist service would help many families with complex medical needs. This avoids unnecessary delays and anxieties. To include the parents/carers in the co-production (development and testing) and relevant stakeholders of the digital platforms is crucial for success to ensure they are user-centred and workable for all who may be involved.

  2. Thank you for sharing this project. We had developed the ISCAN (integrated service for children with additional needs) in SE Wales along similar lines pre-pandemic but without the digital aspect until virtual meetings and consultations became the norm. One important feature which I could not see as mentioned in the project, is the inclusion of agency partners from education psychology, early years, early help as well as CAMHS. Self referrals from families for a particular service  ( e.g OT) may have that need better met by early help or education ALN support. How is this being factored into the project? With the increasing domination of ND referrals to child development services are these being filtered out before hand on on what basis? These points are made as learning from the ISCAN experience if a different type of revolving door to your big main door is to be avoided.

  3. This is a widely shared problem. Keen to hear about your work in co-creating a solution that might be generalised

    1. Thank you, John, for your interest, there have been a few Q members who have highlighted that they are either doing similar work or have the same challenges, so we are conisdering setting something up (potentially a Q online group) with a view of sharing practice in this area.

  4. I really like the idea. I'd be eager to learn more about the "digitally facilitated single point of access". Is this web-based or app-based? And how will this be facilitated operationally and interface the different services?

    1. Thank you Thomas for your interest in our project. The digital interface is to be determined / refined as part of the project as we aim to co-produce this with families, based on how they want to engage with our service and request help. That said, we have the capacity within our services to utilise an app, known as Family Assist to support access. It is likely that although we have one Front Door, the ways in which our families can access the Door may be varied, to ensure that we don't digitally disadvantage families, so we may have app access, but also web based access, alongside more traditional methods (such as telephone advice line). We have costed in additional business support and clinical time to coordinate this and bring together the clinical teams to facilitate a unified triage process - so that requests for support are diverted quickly to the best placed clinician to respond.

  5. Guest

    Colin Barnes 1 month, 2 weeks ago

    This is a fantastic idea with so much potential to improve the way children and families experience services and receive timely care.

    1. Thank you Colin for your support

  6. We’re also looking at this in our service (altho my QExchandge 2022 idea is of a different theme), would be interested to know what the barriers are and how this will be addressed, for example, supporting non-English speaking familiars navigating the complex system? Thanks!

    1. Thankyou Joanne for your comment and your interest in our project, and we are really interested to hear that you are also looking at this in your area. We'd be very interested to link with you and learn from each other. You make a really important comment about barriers to access, for example for those who do not have English as their first language, but also for those who have other accessible information needs or who have difficulties with accessing digital resources. We do hope that the Big Front Door will help to mitigate in part against these barriers, but you are quite right that we need to include this within our quality impact assessments and consider the adjustments or enhancements we would need to make. I think it is also really important that we support the voice of families who may experience these barriers in our co-production efforts, and our parent / carer forums are really well placed to help us with this.

  7. Guest

    MARINA CRAIL 1 month, 2 weeks ago

    This sounds really promising.  Its often something we hear in Special School Nursing and I think would assist families in navigating systems which are not user friendly.  Often parents don't know who they need their child referred to but they identify the need so having one contact to start the ball and have a conversation makes real sense.  It also gives ownership and empowers parents to feel in control of their child health needs.  It would be great to ensure that at co-production stage their are parents from all areas we cover within our services geographically and information about services that may sit outside of Solent commissioning. Also to ensure accessible info. is included as we have a number of parents/carers with their own needs who struggle to access complicated systems/processes/forms.

    1. Thank you Marina, these are really valuable suggestions, supporting the voice of all our parents in co-production is a key element in this project's success.

  8. Thank you, Adrienne, your time to look at and comment on our project is really appreciated. I really appreciate your advice around timing of the workstreams and the redesign process, and we will consider this, if we move through the stages in the timeline too quickly, I think you're right about 'baking' in activity that doesn't help.

    1. Hi,

      I think this is a great idea with huge potential. Given this year's theme around digital and improvement, I wondered how you could draw out the digital elements more clearly. You mention the three different workstreams, but it would be great to see what digital solutions and strategies you are aiming to deploy to achieve this.

  9. I love the idea in principle. I would want to know more about the timing of the workstreams around digital responses to requests and redesigning of the processes - if the aren't done in the right order there is a danger that unhelpful activity is 'baked in' to the digital solutions.

  10. Guest

    Adele Markland 1 month, 3 weeks ago

    I think this is a great idea as it is so hard to navigate around the healthcare system. When I have been involved in QI projects it is really good to engage with the service users/families to understand their current challenges and test out small scale digital solutions. Sometimes what we think are issues aren't the real barriers or challenges. You could perhaps contact your local AHSN to see if they have learning/evaluations around digital projects. Another organisation that might have some learning to share for your project is ORCHA Good luck with your project.

    1. Thank you, Adele, for your comments and advice. We will definitely link in with our AHSN and will also have a look at ORCHA. Thank you for taking the time to look at our project and commenting.

  11. Hi

    This is really interesting to read as we are working on a similar project (in phases) with the first phase being our 0-19 service (Health Visiting and School Nursing) and our mental health services (including our local third sector provider) with a view to subsequent phases including wider services (we provide a huge range). I'm curious how you decided your scope of services. Would also be great to share practice and learning!

    1. Hello Lyse,

      Thank you for your interest in our project and it is great to hear about your similar work. We determined our scope of practice based on the significant overlap between these services with many children being referred to multiple services for the same condition, as well as the feasibility of being able to integrate these services as a first phase. That isn't to say that there isn't overlap with other services too, such as CAMHS and 0-19 as you have indicated and there is potential to develop this in phases as you are doing.

      I'd be really interested in sharing ideas and challenges with you. Thank you for getting in touch.

  12. Guest

    Danielle Eves 3 months, 1 week ago

    This sounds like a great idea that will hopefully stop the parents feeling so overwhelmed by the process. Multi-disciplinary working is always paramount when working with children with complex needs and this new 'One Big Front Door' appears to offer a more streamlined service in which to do that.

  13. Guest

    Michelle Hallett 3 months, 1 week ago

    This sounds like a great idea, it will make it easier for our families to access the correct support that they need. It will provide a holistic approach to their care to help ensure that they are supported to achieve the best outcomes. It will help to save time for the families and staff by having one route to referral for multiple services which will help to reduce overall costs.

  14. Guest

    This sounds like it would be really positive for families whose children have complex needs. Often they feel overwhelmed by keeping track of all the different appointments, therapists, doctors etc they need to see, and exhausted by repeating themselves.

    As a therapist, it would be useful to have all the information together in one place. I already value being able to see shared notes from others professionals, and a shared referral form with the relevant information would help with planning.

    I wonder if the Big Front Door also calls for a sort of 'Doorperson' role, not someone blocking the entry, but someone who can show the parents around once they are through the front door, as the door is only the first part of it, and whether it leads to a big open space with lots of professionals in, or a corridor with a few more doors, parents will still need some support finding their way.

    I'd also like to know any plans about working with services which are outside of Solent, and if there are plans to link with them in a more joined up way.

    1. Thank you Karen for this suggestion, I like the idea of a doorperson, and certainly we are wanting to ensure that families are supported as they navigate the different appointments and services they may need to access.

  15. Guest

    This sounds an amazing idea, there are many successful and not so successful examples across other dimensions of healthcare, so would need feedback from those services. I suppose the critical elements would be robust triage of referrals with an MDT approach.

  16. Guest

    Heloise Young 3 months, 1 week ago

    This will save time and money to our teams as well as provide a holistic treatment approach. It'd be great to have an idea of estimated costs Vs savings.
    I admire this quality improvement idea based on users' feedback.
    I am looking forward to seeing this idea turn into a plan and a reality!

  17. Guest

    Katie Unwin 3 months, 1 week ago

    This sounds like a great idea to help make families' access to support more streamlined and for clinical staff to save themselves and families' time in gathering information and providing the right support from the right professional(s) at the right time.  I can see it working well in the cities where there is already collaborative work across services.  It seems more challenging in other parts of the county where services are currently provided by different Trusts and educational providers.  I'm hoping for an open plan, connected, flexible space behind that Front Door and hoping it's not one Big Front Door with lots of different rooms hiding behind it still...

  18. Guest

    Aishea Buckle 3 months, 1 week ago

    Involving children and families in the Big Front Door will help us to improve the services we deliver, as they have direct experience and they know better than anyone what works and what does not. Having experts by experience as part of the team will bring unique insights and intelligence.


  19. Guest

    Kelda Oldman 3 months, 1 week ago

    This is a brilliant idea! It could be really helpful for parents who feel overwhelmed and have difficulty getting to all their initial assessments without someone to guide them.

  20. Guest

    Jane Hardwick 3 months, 1 week ago

    Good Luck with this project, it sounds fantastic! Great choice for the name too; One Big Door that leads to multidisciplinary working, with a patient centred approach, ensures efficiency and better outcomes.

  21. Guest

    Elaine Davis 3 months, 1 week ago

    What a fantastic idea. One place for families to get all the advise and support they need.

  22. Guest

    Allyson Wild 3 months, 1 week ago

    This will make a huge difference to families in accessing the right support from the right people at the right time. It will also help the professionals/business support team running the services, avoiding duplication of work and waste of clinical time in trying to find the right team to signpost/refer people into.

    I love the name, too!

  23. Guest

    Paula Tyler 3 months, 1 week ago

    Omg 😳 this sounds amazing, as a parent carer of children with additional needs this would save so  much time for the parent and child to be signposted to the correct place at a time of need . From my experience this is very well needed. Unfortunately health visiting team  have such a big busy work load you could be waiting some time just to get an appointment, they could go here and get the correct information and referral which is very much needed . I’m 💯 behind this , good luck Carl and team I’m behind you on this .

    1. Thank you very much Paula for your support for this project. Your experience and your links with other families are going to be so vital to the project's success.

    2. Thank you for supporting and yes we really do hope it will improve work flow and give nurses more time to provide care.


  24. Guest

    Charlotte Jewell 3 months, 1 week ago

    This is such a brilliant idea. It seems extraordinary that something like this does not exist already. Surely it would save time and it would give so much more confidence to the medical and clinical profession and parents alike. I really like the name too; simple and welcoming.

  25. Guest

    Reanne Stanton 3 months, 1 week ago

    This is a fantastic idea!

  26. Guest

    julie waine 3 months, 1 week ago

    A single point of access and the right clinician first time is so important for families for whom attending an appointment can be a massive and stressful undertaking. I really like the idea of an app co-constructed with a family. Not everyone has access to a laptop but most people have a smart phone and being able to provide access to advice out of hours is very important.

    1. Thanks for supporting and by working with parents/families you are right we need to consider choice and accessibility. We are planning on utilising and improving current process as this needs to be part of the 'Big Front Door'. In this we ensure those without access or able to use smartphone get to the single point of access.

  27. Guest

    Claire Blackshaw 3 months, 1 week ago

    This sounds a fantastic idea and will help parents in Portsmouth get the right support in a timely way.

  28. Guest

    Siobhan Moad 3 months, 1 week ago

    This sounds like a fantastic idea! Making things more accessible to families would have a huge impact. Love the name!

    1. Thanks for support. Is the big question, What colour is the Big Front Door? #canofworms

  29. Guest

    Sophie Kynoch 3 months, 1 week ago

    For parents having to repeat their story every time is simply exhausting.  A patient centred approach with a single point of access is a wonderful idea. From experience of working with and supporting vulnerable families in the past, meeting new people, multiple meetings, assessments, professionals and repetition is often such a barrier to getting the right support. Anything to remove these barriers is imperative. Good luck with the project.

    1. Thank you very much for your comments Sophie.

  30. Guest

    Great idea, this potentially will make the referral process so much easier. It will promote multidisciplinary working improving patient care.


  31. Guest

    Corrina Bishop 3 months, 1 week ago

    This project would help simplify the process for children and the families . this project will impact the service for professionals improving efficiency and patient care. children and their anxious families need a simpler way into the care they need

    1. Thanks for liking our idea. We hope by using Experience base design we truly can capture and learn these anxieties and frustrations, so design a Big Front Door which overcomes them

  32. Guest

    Richard Brown 3 months, 1 week ago

    I think this is a fantastic innovative approach that will have a significant positive impact for children and their families who are accessing the service - ensuring that the right support is offered by the right team without delay.  Am really excited about seeing these plans and aspirations become reality

  33. Guest

    Mandi Robertson 3 months, 1 week ago

    Great proposal which will make services more accessible, relatable and demystify the referral process. This will benefit the child and their parents/ caters whilst cutting out unnecessary process, bureaucracy, error, duplication and cost. Should be replicated throughout.

  34. Guest

    Emma Wilson 3 months, 1 week ago

    Such a great project and fantastic that service users will experience a service that's easy to access, responsive and reduces the frustrations families feel when they don't know where to go for help.

  35. Guest

    Anything that makes families' access to the right services at the right time is going to benefit the families, as well as helping stretched services be more streamlined. One point of access for families will make the process much easier for them, so reducing stress and anxiety when they are already concerned about their child and his/her future. It should also ease the process of considering which service/s is/are needed at that time, so reducing clinical time spent rejecting referrals, signposting or referring to a different service and the family starting at the bottom of a new waiting list. It will be important to include times of review/transfer between different services in this new process, as which services are needed will change over time for a child with longer-term needs. In some Hampshire localities this will require outside agencies/other Trusts also taking part in this new process as they fall under other Trusts and County Council teams.

    1. Thank you for your comments Cariad. We are really keen to ensure we evaluate the impact of the Big Front Door on experiences with our current referrals proceses.

  36. Guest

    Rophina Yeld 3 months, 2 weeks ago

    Fabulous idea which will potentially simplify the referral process directly  benefiting families and making it easier for clinicians to refer appropriately and effectively for timely interventions reducing unnecessary time delays expense and frustrations for affected families

    1. Thank you very much for your comments Rophina, really good to get the opinion of our colleagues in Primary Care :).

  37. Guest

    Kerry Mathieson 3 months, 2 weeks ago

    I think this will enable parents to access services in a timely manner without multiple referrals and having to give the same information numerous times. The name makes it sound all encompassing and in turn, reassuring. Good luck with the project.

  38. Guest

    laura dearling 3 months, 2 weeks ago

    Really great idea and so important for families to stop repetition and for them to get the right support first time round. Also i really like the name 'BigFrontDoor' very welcoming.


  39. Co-design on this service is greatly needed and will provide a much needed simplified access point for referrers.  I wonder whether the SEIPS 3.0 model 'SEIPS 3.0: Human-centered design of the patient journey for patient safety - ScienceDirect' would help with the design work for this proposal.

    1. Hi Corrina

      Thanks for commenting and I hope you are well?

      Great point and we are planning to use Experience based design to understand the current process, which focus on touch points and emotional. You have a good point around integrating Human Factors and Ergonomics needs in the single point access. As this will be key to design and usability of it.


  40. Guest

    Michael Smith 3 months, 2 weeks ago

    This sounds like a great idea and much needed for Families who need to get the right advice quickly. All the best with your project!

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