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Overhaul children’s unscheduled care to protect their health, NHS told

Risk that rising demand will result in poorer outcomes if things left unchanged

Caroline White

Wednesday, 29 April 2015

Unless unscheduled care services are overhauled, there is a real risk that growing demand will result in poorer outcomes for children, warn GPs, nurses and paediatricians today as they set out new standards to improve care for this group.

Children make up more than a quarter of emergency department attendances in the UK. And in England alone there has been a 28% increase in admissions for children to hospital over the past 10 years.

Facing the Future: Together for Child Health says that in order to deal with these pressures, and to improve child health outcomes, unscheduled care services need to be designed very differently, so that not only are they more integrated and responsive, but also allow more children to be cared for in the community and closer to their own homes.

The 11 standards, which have been jointly produced by the Royal College of Paediatrics and Child Health, the Royal College of General Practitioners, and the Royal College of Nursing, aim to ensure that specialist child health expertise and support are available to strengthen primary care services, supporting GPs to care for children safely in the community.

They stipulate that GPs assessing or treating children with unscheduled care should have access to immediate telephone advice from a consultant paediatrician, with a link consultant paediatrician for each local GP practice or group of GP practices.

And every acute general children’s service should provide a consultant paediatrician-led rapid-access service so that any child referred for this service can be seen within 24 hours of the referral being made.

Each acute general children’s service should be supported by a community children’s nursing service, which operates 24/7, for advice and support, with visits as required depending on the needs of the children using the service.

When a child presents with unscheduled care needs the discharge summary should be sent electronically to their GP and other relevant healthcare professionals within 24 hours and the information given to the child and their parents and carers.

There should be documented, regular meetings attended by senior healthcare professionals from hospital, and primary care services and representatives of children and their parents and carers to monitor, review and improve the effectiveness of local unscheduled care services.

Dr Maureen Baker, Chair of the Royal College of GPs said: “A quarter of a GPs’ patients are under 19 years of age and the best place for children and young people to be cared for, wherever possible, is close to home.

"Our young patients and their families can't plan when they will be poorly so it is crucial that they have access to high quality services in the community whenever they need them.

"This is not only good for our patients, but good for the entire NHS as care in the community is more cost-effective than in hospitals.”

Dr Peter Carter, Chief Executive and General Secretary of the RCN, added:

“As well as the high number of children being admitted to emergency departments, there is also worrying variation in the rates of attendances and admissions across the UK. These standards are important not only to reduce these inconsistencies, but also to make sure children are getting the most appropriate care.”

He said there would obviously be times when children needed to be cared for in hospitals, but emphasised: “There is no doubt that some episodes of acute illness could be safely and better managed without a visit to the emergency department or an admission to an inpatient ward.”

And he warned: “Investment is urgently needed in community care, especially in community children’s nursing services that can provide crucial support to general children’s services, and offer advice for worried parents.”

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