Paediatrics at the GP's surgery: putting heads together

As a paediatric trainee, I’ve sat through many clinics and been amazed at the depth of knowledge displayed by my seniors.

As a foundation trainee in general practice, I’d had a very different experience – a fear of the sheer breadth of the problems that might appear through the GP’s door. So when I attended my first hub clinic I was thrilled to get to see the two branches come together: the depth of knowledge of the paediatric registrar being used to assist the GPs with the breadth of cases presenting to them.

A GP’s office is not always the most comfortable place to squeeze a large contingent of people into – particularly as so many of them are squeezed into little buildings off busy streets. So when you start with three doctors, and then bring in two, if not three, extra people, it’s easy to expect things to get cramped, uncomfortable and overwhelming. But that wasn’t my experience.

From the first appointment, it was clear how valuable the meeting of minds was. Over the course of the morning we got to see eight cases representing the bread and butter of both paediatrics and general practice: funny turns, constipation, abdominal pain, allergies. Many of the cases were on the cusp of needing outpatient referral – it would take a very confident non-specialist to handle these without referral.

Take the first patient – a six year old with funny turns. The episodes themselves didn’t sound worrying (she was having what sounded like simple vasovagal episodes), and she’d had some normal investigations, which helped rule out anything nasty. However, considering her relatively young age and very anxious (and very Google-aware) parents, it’s not hard to see the value of having an experienced paediatrician present to reassure the family.

Or consider the second, a little boy with really bad constipation who needed clear instructions – and the warnings to come with them – of what was involved in the upcoming treatment to give his mum and his GP the confidence that it would work this time.

After the morning clinic, we then had an MDT meeting with some of the other member of the GP and community team, running through the morning’s cases and discussing a few more patients. There was clearly a wealth of experience among the GP team present, and it was interesting to get their take on the problems as well. Most usefully, perhaps, was a chance to discuss a girl who had been admitted to the ward, because the GPs could give us a much more in depth description of the social and family situations, and how that might impact on her care going forwards.

It’s easy to see how the hub clinics might be useful for the GPs: a chance for discussion and education, to help deal with more tricky patients. What may not be quite as obvious, but is just as important, is how useful they are for the paediatricians who attend, including those of us who are still training.

Usually, a paediatric trainee’s contact with the GP world comes in the form of referral letters or phone calls, which, depending on the stresses of clinical work and the content of the referrals, can sometimes be frustratingly vague. But once you’ve spent time in the GP surgery it becomes clear that those referrals are only the tip of a very big iceberg.

Our GP colleagues are vital in making sure the right children get seen by the right people at the right time, and anything we can do to help strengthen our links with them is a step in the direction of improving care.