1. CYP primary care deep dive Transformation Board 24 May 2018
Eugenia Lee, Georgie Herskovits and Christine Kirkpatrick

2. Background
CYP make up over 40% of the primary care workload – yet GPs tell us they see ‘very few’ young people
Only 40% of GPs are trained in child health
Young women (under 25) visit their GP four times a year and young men twice a year on average
Young people are the age group least satisfied with GP services and with the shortest consultation times
CYP are twice as likely as other groups to attend A&E or walk-in centres rather than see their family doctor
What does GP provide – babies (imms), sexual health, mental health, minor ailments, long term condition management (non complex)

3. National documentation
As well as all relevant disease specific standards and guidance

4. GP Leadership Group Recently refreshed
Members include children’s GP Leads and children’s commissioners from all areas of London
Achievements include: I Statements, e-learning resources, CYP pilots, compendium of services, learning needs assessments, contributing to eating disorders guidance, shared learning and spread of information across London
Well organised,
motivated group of
people who come
together to share ideas,
best practice and local
Innovations [Niamh McLaughlin,
Central London GP]
One of the most useful meetings that I attend
[Tonia Myers, Waltham Forest GP]
Colleagues in this well established leadership group provide great support and share useful resources and experiences in addressing the challenges of commissioning children's services across London [David Masters, Haringey GP]

5. Achievements in 2017/18
Key outputs
Supporting 3 primary care pilot areas (NCL, NWL and SEL) and associated activities in all three areas
Scoping, developing and building the CYP Primary and Community Care Toolkit
How we engage with stakeholders
Launch of CYP pilots for primary care programme and associated event
Research and development of compendium of out of hospital models of care for acutely unwell CYP: new models of care, and associated event
How to transform primary care for CYP, wash up of pilots and associated event
Spreading learning through GPs
GP Leadership Group
Royal Society of Medicine training and education pilot
Londonwide learning events aimed at primary and community care
STP work
Meetings with all STP children’s leads to support them in improving care for CYP
Establishing effective links with HLP primary care team

6. CYP pilots for primary care at scale
The CYP primary care team supported three pilots that aimed to support CYP in primary care
Bexley:
Group consultations
Pharmacy pilot
Learning needs survey
Hammersmith & Fulham:
Asthma event
Prevalence finder
Learning needs survey
Islington:
Development work for paediatric integrated care networks
Tom’s story - developed patient narrative on asthma as a learning tool
Supported them on a paediatric care closer to home event

7. Transforming care for CYP in primary care
Launch of the CYP Primary Care at Scale pilots
Designed to inspire and support spread of knowledge
Attendees heard from:
An international expert
Local experts from across London
Many thanks for the opportunity to be part of the HLP programme… Your participants’ questions were excellent… I learned a great deal from the discussion.
[Prof Al Mulley, Dartmouth Institute]
Excellent examples about general practice hubs, experience from H&F, mental health, and the Wellness Centre in Lambeth… inspiring
[Dagmar Zeuner, DPH]
Thank you and your colleagues so much for hosting this event and [for having] so many passionate doctors talk about what they would like to see happen to make a difference in child health
[Maureen Malcolm RGN]

8. It was very helpful, I would recommend [parent]
Bexley/SEL: Group consultations
HLP supported a pilot in Bexley and Croydon CCGs and Oxleas for CYP with asthma (2 sites) and sickle cell anaemia (1 site).
Consultations were aimed at CYP and their parents/carers.
Findings show that group consultations for CYP offer a real alternative to 1:1s, with significant benefits for children, their parents and staff
Do it. It saves time. It gets you more involved with patients. The patients gave really positive feedback and I had fun [Lyndhurst practice]
It was very helpful, I would recommend [parent]
The time spent in the group was very enjoyable & gave me a “buzz” and positive feeling as a doctor. I felt empowered to change things.
Group consultation is a great opportunity to gather all patient information in more relaxed and fun way while engaging patients, helping them to gather together to discuss their diagnosis not only with professionals but with people that have similar issues and also struggle [Amersham Vale practice]
I found saying to them, ‘Just turn up and see if you like it’ seemed to work. Now they want the sessions more often than I can offer them! [Oxleas]

9. Bexley: Pharmacy project
Opportunistic review of asthma inhaler use in 5-24 year olds
Launched September 2017
Piloted in three GP practices and 15 surrounding pharmacies
Captured on online template
Notification and any follow up needed communicated directly to GP practice. Referral sent for:
Urgent review (within 7 days)
Moderately urgent (within a month)
Pharmacy follow up
Evaluation conducted by CYP team with all pharmacies that took part in training – learning points gathered for expansion of project and uptake by other areas.

10. Pharmacy project: Next steps
Bexley CCG is now looking to expand the programme borough-wide and increase the eligibility age range up to 25.
Greenwich, Islington (possibly NCL as a whole) are looking to use the learning to develop similar schemes in their boroughs.
The platform is to be offered for free to all interested CCGs in London.
The CYP team will promote this and the project more generally through the CYP toolkit.
“A lot is growing from both the asthma in pharmacies and the group consultations projects …Even just raising the profile of asthma last year may have had an effect as we have had a drop in numbers of children attending A&E and also on admissions it seems”
[Karen Upton, safeguarding and asthma lead, Bexley]

11. Hammersmith & Fulham
Multi-stranded project focused on improving asthma care for CYP in northern (most deprived) area of the borough
Asthma event for professionals, CYP and parents/carers: Nov 2017
Weds 1 November

12. Hammersmith & Fulham Inclusion Exclusion Asthma prevalence finder
Adapted for use on GP records system (SystmOne and Vision) and tested locally
Inclusion
Exclusion
Any bronchodilator
Any inhaled corticosteroid or prednisolone
Any cough or wheeze
Within past 12 months
Any asthma code - ever
Age <2 or >18 years
Extensive evaluation and testing of the prevalence finder found it to be too sensitive and not specific enough as it highlighted many CYP with seasonal viral wheeze.
Next steps: A London-wide clinical working group will be debating how to adapt the inclusion criteria (for example 2 episodes in the past 12 months?) and make recommendations for roll out of the tool.

13. Islington Networks Tom’s story Supporting CCG
Supporting the CCG with development work for paediatric care networks across Islington
Tom’s story
Developed a narrative and audio (‘Tom’s story’) for a vulnerable patient with asthma and how their care could be better managed in an integrated system.
Tom’s Story available for others on the Primary and Community Care Toolkit as a learning tool
Supporting CCG
Supported the CCG at a paediatric care closer to home event

14. Learning needs assessments
The CYP team developed a learning needs assessment for the areas undertaking pilots to understand levels of confidence among primary care staff in the treatment and management of CYP. In both areas, the assessment was publicised through local channels.
This tool is now available for other areas to use.

15. Thanks for setting up yesterday’s event, it really was inspirational.
How to transform primary care for CYP event – April 2018
Wash up event to conclude learning from pilots programme and other innovative practice
A practical and inspiring event for everyone working with CYP in primary and community care
Speakers – Michael Marmot, Sam Everington, Giles Armstrong
A set of workshops to offer solutions to issues facing primary care today
A marketplace of innovative tools and services focussed on CYP
Thanks for setting up yesterday’s event, it really was inspirational. 
I found it to be a very useful networking event, with some excellent presentations.
It was such a great event! Thank you for the opportunity to have a stall! We had a great time chatting with people about our projects, and also in hearing what other great projects people have been working on.
I thought it was excellent, so well organised and incredibly interesting. It’s always really nice to be recognised and have the opportunity to share our work…The trainees said that it was a really useful learning opportunity.
Link to CYPHP newsletter with feedback about the event

16. Compendium of out of hospital (OOH) models of care
Case studies for commissioners and providers of out of hospital healthcare services for children
Different services are described to help others understand what some areas are already doing
Information collected directly from services
A local contact identified at each service
Details of how other organisations have developed place-based models of care for treating acutely unwell children and young people in the most appropriate location for their needs

17. Transforming OOH care for CYP event: June ‘17
Over 100 attendees
A full day programme of speakers and presentations
A vibrant, packed marketplace of innovative and inspiring models of care for CYP from all over the country
It really was a fabulous day with great speakers and networking. I look forward to attending your future events
[Nicky Packham, COAST Team Leader]
Thanks so much for your amazing work in setting up and running such a superb day – if anything will encourage people to really think differently then it is days like this.
[Bob Klaber]
Thanks for a very inspiring and educational day. I want to share the [out of hospital] standards locally within our care closer to home group
[Sanjay Suri, consultant paediatrician]

18. I Statements for young people in primary care
The following core statements were developed by GPs and young people in London.
They describe the care that young people can expect when they go to see health professionals in primary care (GPs, practice nurses or others)
I expect to be treated with respect and believed
I expect my cultural and religious beliefs and sexuality to be respected.
I expect my consultation to be confidential.
I would like to be able to access the service at times when I am able to attend (eg. outside of school/college hours) and to reach the service easily, in person or via an app.
I expect to be able to see a doctor or nurse on my own if I choose….

19. CYP primary and community care toolkit
Landing page

20. Example page: working with pharmacy

21. Networked primary care for CYP [using asthma and mental health as examples]
An initial workshop on what good networked care for CYP in London should look like suggested clear principles for networked care, a description of how pathways should work (eg. opportunities to self-refer) and network components.
Participants agreed that there is great potential to use workforce differently
Take away messages included:
Continue momentum
Co-produce with whole system
Work more closely with GPs
Ask CYP
Don’t reinvent the wheel
Schools are a natural hub
Use technology

22. Networked primary care for London’s CYP
Linkages
Parents
Key worker
Youth Workers
Specialist nurses
Eg asthma nurses, diabetes
nurses
Schools & Colleges
Link with school nurse – attend MDT
CAMHS
Health Visitors
Health & Wellbeing practitioner
Local Authority
Voluntary Sector
Networked primary care hub
30 – 50,000 pop
9am – 11pm
Employed by primary care?
HCA?
Dedicated CAMHS worker or link?
Social prescribing
Link with practices
Care navigator
GP/GPwSI
1 GPwSI per hub?
In-reach or out-reach with paediatricians
Dermatology clinics
Hotlines
Hospital Trusts
Shared IT system /records
Sexual Health Services
Pharmacy
Leadership – from primary care

23. Networked primary care hub for care of CYP with asthma

24. Training/education for primary care professionals
Development of education compendium (linked to toolkit) to support primary and community care staff with free online modules of CYP focused training
Working collaboratively with the Royal Society of Medicine to develop a curriculum for a programme in primary care paediatrics and child health which covers recommended basic knowledge of paediatrics for GPs
Pitched at a basic level making it more accessible for GPs who have had minimal previous training opportunities in paediatrics. Its aim is to improve GP confidence and ability to manage common and serious paediatric conditions
The Programme would be recognised and accredited by the Royal Society of Medicine

25. HLP CYP engagement activities
Engagement activity
Numbers of people engaged
Three large scale events
300+
Pharmacy training Bexley – session 1
30+
Pharmacy training Bexley – session 2 (Local Pharmaceutical Committee)
50+
Hammersmith & Fulham training
30+ staff, 40+ patients/parents
Bexley community pharmacy evaluation 20
Programme for Integrated Child Health (PICH)/other training and mentoring opportunities by clinical lead
250 +
Nursing event 2 May
65+
Group consultations
10 staff, 30+ patients/parents

26. What will be retained for 2018/19
GP Leadership Group – a group of CYP clinical leads meet 4/5 times a year to network and share ways to improve the care of CYP
Launch of primary and community care CYP toolkit and ongoing development
Development of networked care model for CYP in primary care using asthma as an exemplar
Refinement of asthma prevalence finder and development of virtual working group
Support of roll out of pharmacy asthma inhaler initiative
Learning needs assessment and Royal Society of Medicine education and training work
Networking/showcasing events