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.