Child health GP Hubs, a newcomers perspective

I began my four-month rotation in ‘integrated paediatrics’ with very little idea what to expect. My clinical experience as a doctor thus far had consisted solely of busy, ward-based hospital roles, and the concept of an integrated care model was an entirely foreign one. I remember receiving a multitude of explanations about the ethos behind Connecting Care for Children and the Child Health GP Hubs, but it was only when I witnessed the Hubs first-hand that I fully grasped the concept and came to understand the benefits.

How do the Hubs work?

Each Child Health GP Hub is a small network of up to five GP practices situated close to one another, and meets once a month, with staff from all the constituent practices in attendance. In essence, the Hub acts as a ‘gateway’ to secondary care: where children with more complex health problems would traditionally be referred by their GP to see a paediatrician at the hospital, the Hubs provide specialist input for these children who can be managed by their GPs with some added support. Those cases that are deemed more complex are still referred on to secondary care.

The first part of each Hub meeting consists of a multidisciplinary team (MDT) meeting. This is attended by a paediatrician from the hospital, GPs from all the constituent practices, local health visitors, paediatric dieticians, physiotherapists, occupational therapists, and child and adolescent mental health services (CAMHS), just to name a few! The GPs present complex cases of children they have seen during the previous month – each case is discussed openly and a plan is agreed on how best to proceed. In some cases the child is referred on to a specialist or booked in to the Hub Clinic to be seen by a paediatrician, whilst at other times advice on further investigations or management can be provided.

The vast array of experience and knowledge in the room makes for an absolutely brilliant learning environment, with professionals of various disciplines each drawing on their past experiences and sharing their unique perspectives. It’s not just the children who benefit – everyone in the room takes something away from the MDT meeting and becomes better as a result!

The Hub Clinic, where children are booked in by their GP to see a general paediatrican, follows the MDT meeting. Crucially, the child is assessed by the paediatrician together with their GP – both are in the room together. The GP’s familiarity with the child’s background is coupled with the expertise of the paediatrician and the luxury of sufficient time in order to be thorough, thus delivering a genuinely excellent level of care. The GP is also fully informed of the outcome, meaning they are able effectively to co-ordinate the child’s care based on agreed actions from the consultation. The continuity of care is a huge upgrade on the traditional model, where written correspondence is exchanged regarding a child’s care, between multiple clinicians each based at different locations.

What do GPs think?

The opinions of GPs across different Child Health Hubs have been overwhelmingly positive. Aside from the obvious benefits to the children who are seen and discussed, many cite the learning from the MDT discussions and joint clinic consultations as the outstanding aspect. That common childhood illnesses, such as asthma, constipation and cow’s milk protein allergy, to name just a few, are seen and discussed quite frequently at the Hubs serves to consolidate learning, and as such has exponentially increased GPs’ confidence in dealing with these problems in future, often independently. In fact, from personal experience of clinics at some of the longer-running Hubs, many consultations merely consist of a paediatrician reassuring parents and agreeing with their GP’s initial management plan – this level of competence is a direct result of the aforementioned learning from the Hub clinics and MDT meetings.

What do the patients think?

Again, there are too many positives to be able to list them all. Many parents prefer their children to be seen at a local GP practice as opposed to the hospital outpatients department – it’s closer to home, easier to get to, and a more familiar environment. Their children are seen in the Hub clinic within four weeks, whereas waiting times for hospital appointments may notoriously extend to several months. Most crucially, through the joint clinic consultations, the Hubs increase parents’ confidence in their GPs to manage their children’s present and future health problems – an immeasurably powerful outcome given the often-negative publicity regarding our health services in recent times.

Child Health Hubs are better for children, better for parents, better for GPs, and better for all those who come along and learn. What’s the catch, you ask? I actually have yet to find one, and I don’t think I will. My main question is – Why aren’t we doing this in other areas of healthcare? Given the well-publicised problems with the elderly population being in and out of hospital, could we not apply a similar concept? In any case, I’ve learned a huge amount during my time working with Connecting Care for Children, including many ideas and concepts that I had no idea even existed 4 months ago! My eyes have been opened to what can be achieved when healthcare services are effectively linked, and the benefits of incorporating both professional and patient education into healthcare initiatives – hopefully these are lessons that I can take forward, build on and apply in my future career.