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GP/paediatric registrar scheme cuts referrals and A&E visits

‘Learning together’ pilots also reported jump in clinical guidelines compliance

Louise Prime

Thursday, 12 May 2016

Rates of referral or A&E visits were reduced when GP registrars and paediatric registrars worked closely together in a pioneering scheme piloted in London, and compliance with clinical guidelines also shot up, a joint paper from the Royal College of General Practitioners (RCGP) and the Royal College of Paediatrics and Child Health (RCPCH) has revealed. The great success of the pilots has led the Colleges to recommend that commissioners nationwide consider adopting similar models.

The RCGP and RCPCH explained that the innovative ‘Learning Together’ scheme, recently piloted in London, involved GP and paediatric registrars in their final year/s of training working side by side in clinics, so that they could share ideas and learn from each other. In their joint position paper, Learning Together to Improve Child Health, the Colleges reported yesterday that the pilots led to referral or A&E visits being avoided in 55% of appointments and saw compliance with clinical guidelines move from 57% to 76%.

Seeing the results of the pilots, the Colleges advocated that similar models of interprofessional training – adapted to suit local need, where necessary – should be adopted by commissioners across the country, and for trainees at all stages of their careers, in order to enhance standards of care and reduce strain on services. They said that bringing registrars together in this way not only gives them more opportunities to learn from one another, but also improves children’s health outcomes and reduces costs to the healthcare system.

The report recommends that:

  • trainee GPs should spend time in specialist settings such as hospitals alongside paediatricians, to expose them to large numbers of sick children in safe, supervised environments
  • GP training is extended to four years to include specialist child health training; and even after training
  • paediatricians should spend time working side by side with GPs and other primary care professionals in general practice settings
  • GPs and consultant paediatricians should spend time working side by side in general practice and specialist settings.

RCGP honorary secretary Professor Nigel Mathers said: “A quarter of patients in general practice are under 19 years of age, so it is important that GPs are able to share knowledge and skills with our paediatrician colleagues in order to ensure that our young patients receive the best possible care.

“This important report adds further weight to the College’s calls for GP trainees, as part of an enhanced four-year training programme, to receive specialist-led training in child health – but also puts forward a number of proposals that should be beneficial for both GP and paediatrician trainees alike.

“We hope that ultimately, if implemented correctly, the recommendations in this joint paper will improve the quality of care that both GPs and paediatricians can deliver to our young patients.”

Dr David Evans, vice president (elect) for training and assessment at the RCPCH, added: “Through the integration of services in primary and secondary care, service delivery will be enhanced and the quality of care to children and their families will be improved. The results of the Learning Together pilot show how effective models such as this can be ...

“With NHS reforms ongoing and a shift towards healthcare closer to home, this type of exposure is very important for future general paediatricians as some are likely to spend more time out of the hospital setting.”

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