Integrated paediatrics and Connecting Care for Children
Integrated paediatrics was the last four-month rotation of my two-year junior doctor’s foundation training programme. Before this I had busy, clinical, service provision roles in A&E, medicine and surgery. When I started in integrated care I found it a very different experience and way of working.
Integrated paediatrics and the Connecting Care for Children (CC4C) team aim to implement changes in healthcare using patients as the primary driver. They work alongside patients, GP practice champions and the general public to determine ways to improve engagement with current services and importantly generate new ideas on how to improve healthcare.
I now appreciate how lengthy this process can be. For example, I have seen colleagues try to change how we manage wheeziness in young children, including how we support families to ensure uptake with prevention strategies and compliance with treatment. It is challenging to get sufficient uptake in focus groups and in general everything takes more time than you might account for. However, the information which can be gathered in this way is vast and supersedes what doctors or other healthcare professionals may think the problem is.
My project focused on adolescent healthcare. When I did my A&E rotation I found that we did not always take the opportunity to screen young people who presented to the department for various stressors that typically present in adolescence. For example, there is evidence to suggest that young people who commit suicide usually have had a history of self-harm and have been seen by healthcare professionals in the months leading up to their death. As professionals we have a duty of care to hold open conversations with adolescents and to screen for risks using a standardised psychosocial history. I have worked with professionals in A&E, paediatrics and the children’s safeguarding team to devise a teaching tool in this area. I have written a questionnaire to assess trainees’ confidence in this topic over the course of the year at Imperial. Additionally I have started work on a pilot study in which every child between 13 and 18 years of age seen in A&E will have a risk assessment completed regardless of their presentation.
I chose this job as I was considering a career in paediatrics. I prefer working with children and never fail to be stimulated by their stories. I have really enjoyed the clinical experience gained at Hammersmith Ambulatory Unit. I am far more confident with common complaints such as constipation and neonatal jaundice and certainly feel more comfortable identifying a healthy child and knowing when to be concerned and seek help. I am happier in this clinical environment than an academic one, so I have found the academic and research focus of the CC4C role a personal challenge. However, this role has definitely broadened my understanding of how the NHS is changing and how patients will play an increasing role in improving healthcare.