Connected Care for Children (CC4C)

Think big, but start small. All you need to get going is one eager paediatrician, GP and someone to help with the running of the hub. Together you can build your team’s work around the needs of local children and their families.

Bob Klaber, Consultant Paediatrician & Director of Strategy, Research & Innovation, Imperial College Healthcare NHS Trust London Borough of Westminster

About the partnership

1. Connecting Care for Children (CC4C) is based within the children’s health team at St Mary’s Hospital. They work with GPs, NHS colleagues, local authorities, citizens and community organisations to change the way children’s care is delivered.
2. CC4C have developed a network of community-based champions who work with paediatricians and GPs to support their local population and share learning. They also support healthcare professionals to develop the skills and knowledge to provide child health care locally.
3. CC4C have implemented Child Health Hubs in GP practices which bring four to five practices together to meet the needs of the local population using one practice as the centre of care. Paediatric consultants from the local hospital join GPs and other health and care staff to work together for local children.

What has gone well

1. The Child Health GP Hub model enables all health and care professionals involved in a child’s care to have regular contact. Patients benefit from fewer appointments – they are seen in the right place, by the right person, at the right time and often in their local GP.
2. Clinicians who join the hub benefit from easy access to secondary care clinicians through the paediatric consultant in their hub.
3. Shifting the focus away from outpatients and payment by results to an approach that focuses on patient need was a key challenge – demonstrating the efficacy of an integrated out-of-hospital approach has begun eroding this mindset.

Results

1. In one hub, 39% of new patient hospital appointments were avoided and 42% of hospital appointments were shifted to GP practices.
2. Smaller hubs in early stages of implementation had less impact on hospital activity.
3. According to a 2016 evaluation, ‘Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP.
4. All respondents said they would recommend the service to family and friends.

What made the difference

1. Whole population approach: The CC4C model builds on a ‘whole population framework’ that segments the child population into 8 levels to drive prevention and improve equity.
2. Multi-disciplinary teams (MDTs): At each of the 8 levels, an MDT bringing colleagues from all partner organisations together, including social care, education, dentists, the voluntary sector, carers and children and young people themselves.
3. Asset-based approach: CC4C is based on connections between clinicians across organisational boundaries; taking an asset-based approach to understanding existing relationships and building on these over time enables partnerships to develop continuously.
4. Community champions: Engaging a range of community champions ensures those who use the service have a say in how it operates.