Q Exchange
Online Collaborative learning through a Paediatric Referral Cafe
- Shortlisted idea
- 2024
What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?
Child health services are under significant pressure with Emergency Department presentations and outpatient referrals increasing faster than population growth. Many systems are now at activity beyond pre-COVID levels. The reasons are multifactorial but include changed caregiver expectation and insufficient paediatric knowledge in the workforce.
Key clinical leaders in the Leicester, Leicestershire and Rutland health system from Primary care, Children’s Emergency Medicine and Paediatric services recognised the need to address unmet demand but also the lack of regular interactions between those referring for and receiving children with paediatric health issues
A barrier to cross system discussion is the additional time it takes to contact a specialist for advice. Current pathways do not always guarantee availability of specialists for advice due to workforce and system demands. By financially resourcing both primary and secondary care this project recognises the additional time required by both parties to initiate and maintain a collaborative discussion forum.
What does your project aim to achieve?
An online referral cafe has been proposed to bring paediatricians and Primary Care Clinicians together to discuss potential referrals and allow discussion about the best treatment options or optimal patient pathways
The objective to deliver a regular online meeting, via Teams, delivered in relaxed ‘cafe’ format that allows General Practitioners and Primary Care Clinicians funded time to present their cases. Clinically, this aims to improve efficiency and the patient journey by getting the correct interventions earlier and referrals in place in the first instance.
The aim is to allow collaborative learning and hopefully avoid referrals which don’t need a Paediatrician to see the child or young person face-to-face (or are more suitable for a different service). It’s likely that common referral patterns are present and therefore learning from the answer to discussion of cases will be beneficial to a wide variety of GPs and Primary Care Clinicians on the call.
How will the project be delivered?
The referral cafe will be hosted by paediatricians and GPs experienced in managing group discussions and used to working with a collaborative and constructive mindset. Sessions will be recorded so that those not able to attend will be able to watch sessions.
A limited multi-disciplinary meeting been trialled in Leicestershire with two PCNs. The results have been positive and we have seen a reduction in referrals, but this has not been done on a wider scale or in an open format as suggested above.
There will be a clearly defined process to ensure patient data is protected but also allowing collection of data for audit and evaluation of the service and an evaluation will be undertaken both qualitatively and quantitatively of common questions, referral patterns and reported behaviour change.
How is your project going to share learning?
We have close ties with regional and national Children and Young Peoples teams and would ensure this work is presented at regional and national meetings.
Following a full evaluation we hope to provide a proof of concept that could be shared and adopted widely to help address issues around elective and UEC demand and workforce skill and confidence that are common across all regions. We wish to promote “one team” integration between primary and secondary care and provide a blueprint for a model of collaborative working which breaks down the barriers that have hindered widespread adoption of similar pathways in the past by recognising the importance of direct communication between colleagues.
We would like to learn from others who’ve adopted a similar approach and gain insight from their successes and learning and the Q Exchange Community will be a perfect vehicle to do this.
How you can contribute
- We would value feedback on how this would be received by primary care colleagues and any potential barriers that could be predicted from the experience of others.
- Are any other systems doing something like this?
- Do you think we should consider this just for specific paediatric conditions or open to any potential referral?
- If you are a GP - is this something you would interested in?
- Should we consider including community paediatrics and CAMHs in the discussion - this could be something we comment on or could be included in a future model. It would be really useful to comment on having a physical/psychological/social approach to cases and ensuring that external agencies signposted to during discussions. Could we open up the café to other professionals such as school nurses and health visitors?
Plan timeline
| 27 Feb 2024 | Preliminary Submission |
|---|---|
| 17 Mar 2024 | Commence Dissemination of learning |
| 20 Mar 2024 | Dissemination and Socialisation |
| 15 May 2024 | Short List Result |
| 9 Jun 2024 | Start Project Set-up and System Awareness |
| 16 Jun 2024 | Start to Deliver Pilot Cafes and Feedback |
| 10 Nov 2024 | Commence Evaluation and Write Up |
| 12 Jan 2025 | Test Theories and Assumptions |
Comments
Michelle L Keane 12 Jun 2024
This idea looks great to me.. Surely will be a virtuous circle with learning in both directions and development of positive working relationships.
Rachel MacDonell 5 Jun 2024
HI Damien and Team, I love the idea of this project and wanted to share an Irish experience here: https://www.irishtimes.com/life-and-style/health-family/one-small-change-a-daily-phone-in-hour-for-gps-to-contact-hospital-consultants-1.4810221
While I was looking for the article I came across this too: https://www.hsj.co.uk/technology-and-innovation/advice-from-emergency-consultants-one-phone-call-away/7025580.article
Best of luck! Rachel
Damian Roland 6 Jun 2024
Thanks for highlighting these - definitely points to consider, and demonstration that daily rather than weekly/fortnightly sessions are possible!
Jenny Marshall 24 May 2024
Hi - interesting proposal! I haven't worked in CYP care, but I can provide an example of a slightly similar process in an adult mental health team.
I previously worked in a Specialist Psychotherapy Service (SPS) which had a 'query line' system for potential referrers. This isn't the open forum cafe style you're planning here, but it was an opportunity for a direct conversation between the PCN clinician and an SPS clinician about whether a referral to the service would be appropriate, and would be accepted. The system involved clinicians designating timeslots in their diaries for admin to book PCN referrers into, and the call would take place at that time.
We monitored this data over time by recording the date of the phone call, how long was spent on the phone, the amount of prep time before/after the call, and whether the phone call resulted in advising a referral into the service or being signposted elsewhere. I don't have the exact figures, but I remember it being a high proportion (~70%) of conversations resulted in the referrer being signposted to another service. In this service, the team felt this was a good use of time because the phone call took less time that the triaging process, which might involve back-and-forth correspondence to the referrer for additional information, especially when the outcome was that the referral was rejected. This was also detrimental to the person being referred because they would be waiting a number of weeks, sometimes months, to be told they were not accepted to the waiting list.
Have you planned the length of the cafe forums and the frequency? Also, I wonder how cases discussed would be prioritised - would it be a drop-in session, or a more structured MDT meeting style with clinicians having specified times to discuss their patient?
Damian Roland 24 May 2024
Thanks Jenny - really useful to hear your experiences!
The volume of referrals may make phone call discussions challenging in all cases but ideally this process should improve the quality (and potential quantity)
Provisional plan was to have a 1-2 hour meeting fortnightly but this needs some working up with local staff to determine the practicality. The aim was for a drop in session but again we may test via PDSA about which approach works best.
Thanks again for your comments!
Hanna Robbins 3 Mar 2024
Sounds like an excellent project
GP time would need funding at locum rates, what about consultant rates? How do we free clinicians up to have these conversations? Would there be a fortnightly forum for example?
Damian Roland 4 Mar 2024
Thanks Hanna!
The aim would be to fund both GP and Consultant time; whatever is required to release from current activity or enable them to add on activity to current job plans.
We are currently thinking about a weekly or forthnightly forum. We may need to do some prepatory work on how we best arrange these (days/times etc) to maximise opportunity to attend.
Any suggestions you have gratefully received!
Damian
Evelyn Prodger 26 Feb 2024
This is a really interesting proposal - I would be interested in understanding what success looks like.
Damian Roland 4 Mar 2024
Thanks Evelyn.
What does success look like - Brilliant question. We've discussed as a team what outcomes would be.
I think we must be honest. In a pilot venture like this I think its unlikely we are going to be able to materially effect overall referral rates and/or ED attendances. We do believe we should be able to demonstrate engagement, change of referral patterns and participant satisfaction.
Very open to metrics to utilise here from groups who have done similar things?
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