What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Early access and support are pivotal for children’s health and wellbeing. Getting the right support at the right time determines a child’s longer-term outcomes. This is prioritised in the One Gloucestershire integrated care strategy. Ensuring clinically appropriate referrals are identified and children are seen by specialists is a driver for this.

Staff intelligence and single point of access data illustrates a high level of rejected referral rates for our community paediatrics service.

Challenges include:

·       Triaging and responding to referrals takes time, the opportunity cost being available clinic time to assess children in need of support.

·       From the referrer’s perspective, costs include additional time communicating back to the family and the impact of managing frustrations if an alternative isn’t available or isn’t known.

·       For families and educators, the process is protracted and opaque, an additional stressor whilst trying to meet the day to day needs of the child.

What does your project aim to achieve?

Core broad objectives include:

·       Supporting delivery against ICB strategic priorities in addressing adverse childhood experiences

·       Staff having a better appreciation of the range of potential services available to children and their families, and signposting to these

·       Positive impact on referral rejections rates

·       Increased access and utilisation of services which can support people whilst waiting for treatment, or when signposted following a referral rejection

·       Improvement in children’s physical and mental health outcomes associated with reduced waits for treatment

·       More equitable distribution of support offering and waiting times. Utilisation of population health management approaches alongside quality improvement methodology will enable targeted signposting to epilepsy related community supports for in line with the children’s Core 20 PLUS 5 for those who may benefit the most.

The intervention itself is primarily focussed on staff groups, however the beneficiaries include children, families, and staff.

How will the project be delivered?

People:

Delivery will be through an ICB quality improvement programme manager and facilitation manager, collectively allocating ~0.4 WTE. Clinical expertise and engagement are pivotal, therefore identifying ~0.1 WTE time from a GP/appropriate clinician is planned.

Core project membership will include the clinical lead and programme director for CYP and clinicians in the community paediatric service, with consultation with other pathway users during the project to review milestones and risks against the plan.

Measuring impact:

Impact will be represented in a range of modes, not limited to:

·       Changes in value added time and/or lead time within the referral process

·       Changes in quality/quantity of community paediatric referrals

·       Changes of quality/quantity to referrals to other services

·       Qualitative changes in user experience of the pathway, either patient or provider

Unintended consequences:

Changes to the identified pathway may impact other pathways/services. To mitigate, effective stakeholder mapping and engagement through testing and implementation are advised.

How is your project going to share learning?

Partnership working is a celebrated strength of Gloucestershire’s ICS. The project addresses a core strategic priority for the system and will benefit from pooled system resource to showcase this, emphasising the added benefits of applying improvement methodology to priority challenges.

The following modes are suggested:

·       Reporting to share lessons learnt and achievement outcomes in relation to the project aim locally, and via Q network channels

·       Reporting to share learning and benefits from utilising a collaborative and consultative quality improvement approach to an ICS challenge locally, and via Q network channels

·       Case study to be utilised within local system quality improvement training curriculum

·       Case study showcasing in local improvement community channels, including the AHSN and local CYP health and care networks

·       Feature on ICB extranet site

·       Social media engagement via appropriate identified channels