Integrating primary and secondary care for children and young people: sharing practice

Abstract

ObjectiveTo share innovative practice with enough detail to be useful for paediatricians involved in planning services.DesignA review of practice, adopting a realist approach.SettingWe collected detailed information about five initiatives which were presented at two meetings in July and October 2014 and telephone interviews between July and November 2014 with key informants, updating information again in February 2015.ResultsThe five case studies involved three clinical commissioning groups (CCGs): Islington CCG and Southwark and Lambeth CCG in London and Taunton CCG in the Southwest. All five initiatives involved acute paediatric units. We heard about four distinct types of services designed to bring paediatric expertise into primary care and/or improve joint working between paediatricians and primary care professionals: telephone multidisciplinary team, hospital at home, general practitioner (GP) outreach clinics, and advice and guidance. We defined four common ways that initiatives might work: promoting shared responsibility; upskilling GPs; establishing relationships between paediatricians and primary healthcare professionals; and by taking specialist care to the patient.ConclusionsWe derived common aims and mechanisms and generated programme (mid-level) theory for each integrated care initiative about how they might work. These descriptions of what is being done can inform debate about which interventions should be prioritised for wider implementation. There is an urgent need for evaluation of these interventions and more indepth research into how mechanisms and their effectiveness could be assessed.

From programme theory to logic models for multispecialty community providers: a realist evidence synthesis

“…Just one study 76 suggested that MDTs encourage family and carer support for patient care. In five instances of MDT initiatives in the UK, enhanced access strategies of telephone MDT, Hospital at Home, and Advice and Guidance services produced better patient experience and less inconvenience and disruption for patients and families, and gave them extra skills and confidence to look after their unwell child without professional support.…”

“…[86][87][88] It also shifts providers' expectations for communication and increases their awareness of the importance and benefits of involving other primary care providers in complex cases, 89 upskills primary care providers and promotes shared responsibility. 76 A narrative case study of mental health integration in a CCM showed that this co-support across disciplinary boundaries helps members of each profession not to feel alone in the face of complex multimorbidity issues about which they are not specialists and to make shared decisions on complex problems. 66 …”

“…67 Multidisciplinary teams varied in their occupational membership and, therefore, the services that they could provide without external referral. The 76 A survey of ACO-employed social workers found that 65% worked with primary care physicians, 55% with specialty physicians, 74% with nurses or nurse practitioners and 31% with psychologists. A total of 48% had a nurse or nurse practitioner as their immediate supervisor, 25% had a social worker and 4% had a manager.…”

“…In five instances of MDT initiatives in the UK, enhanced access strategies of telephone MDT, Hospital at Home, and Advice and Guidance services produced better patient experience and less inconvenience and disruption for patients and families, and gave them extra skills and confidence to look after their unwell child without professional support. 76 Causal link 3:6 -multidisciplinary team working produces informational continuity of care…”

“…l Children's services -for the NHS, Woodman et al 76 report four ways of bringing paediatric expertise into primary care and/or improving joint workingi. telephone-based MDTs ii.…”