The aim of Connecting Care Children's Hubs (CCCHs) is to improve the delivery of care to children and young people by increasing the connections between GPs, health visitors and paediatricians. The core elements of the hubs are that they are centered in primary care and built around a monthly multi-disciplinary team (MDT) meeting followed by a clinic in which a paediatrician and a GP see children together. The project, which was funded by NHS England, began in April 2018 and was led by the Hampshire Isle of Wight (HIOW) Sustainability, Transformation and Partnership (STP) children's programme team:
12 CCCHs were initially piloted across Hampshire and the Isle of Wight:
Impact of the CCCHs:
In addition, the introduction of the hubs was associated with reduced rates of urgent GP appointment, A&E attendances and admissions to hospital:
The NHS is now looking into ways to roll out the CCCHs across Hampshire, IOW and Dorset so that all children can benefit from them.
To hear more about the hubs from the people involved about them, click here.
Parents commonly call NHS 111 when they are concerned about their child. The current system used by NHS 111 involves call handlers going through a series of pre-written questions (NHS pathways) to decide what is required. Unfortunately, this process almost always results in parents being advised to seek a face to face appointment with a doctor. However, at this face to face appointment, most parents are simply told that their child requires no specific treatment and that they can be managed at home. This process is often inconvenient and frustrating for parents and children alike.
We secured funding from NHS England in 2019 to create a new way of delivering NHS 111 services for children. Phone calls about children with common illnesses such as sore throats, ear infections, rashes and cough and colds will be filtered into a specific children's service (paediatric desk) where trained paediatric nurses and GPs will decide whether they can be managed at home or not. If they can, they will provide you with clear information on what to look out for and what to do at home to keep your child comfortable (safety netting).
Phase 1 of the project was completed in July 2019 and the results from it can be accessed by clicking here.
Phase 2 began in October 2019 and finished in January 2020. It involved an expansion of the pilot to children of all ages as well as those presenting with a broader range of illnesses. It also included the ability for the paediatric desk staff to 'talk' to a parent with a video call if required; this allowed the clinician to gather even more information about the child before they made their decision about whether they needed to be seen in person or not. Evaluation of the pilot once again involved comparing the outcomes of children managed by the paediatric desk to those managed using the standard NHS 111 pathways. The results can be seen below:
Based on this successful pilot, we have advocated for a dedicated paediatric desk to be introduced across Hampshire and the Isle of Wight. This is due to be launched in January 2021.
Antibiotics can be lifesaving in children with severe infections. This includes conditions such as sepsis and meningitis. However, overuse of antibiotics results in antibiotic resistance; which means that the normal antibiotics used to treat your child may be less likely to work when your child needs them most. Most mild infections in children get better by themselves; antibiotics rarely make a difference to how long your child will take to get better. For this reason, a project was set-up between pharmacists and general practitioners in West Hampshire to improve antibiotic prescribing in young children.
The intervention involved pharmacist-led in-house training based on the Healthier Together resources and regional antibiotic guidelines, as well as review of antibiotic prescribing data within each GP practice.
The results show that this simple intervention was highly effective in improving antibiotic prescribing in primary care. It is planned to roll-out this approach across Hampshire and Dorset.
For more information, watch this video by clicking here.
In February 2018, the Mental Health Foundation released
worrying statistics that 1 in 10 children suffer from depression or anxiety
related issues, with almost half of cases involving children under the age of
14. What is of greater concern is that over half of schools in the UK are not in
a position to help these children even though they are often the first point of
contact for anxious parents looking for help.
The Healthier Together team decided to partner with the
charity Simon Says in 2018 to develop
educational resources to support teachers and children about mental health. The
“Let’s Talk About Mental Health” project aimed to:
The resources were piloted in 6 schools across Hampshire,
with 30 teaching staff involved and nearly 400 year 3 and 4 pupils (aged 7 to 8
To view the resources developed, click here.
The feedback from teaching staff included:
Children were surveyed before and after the project:
To view the final report, click here.
The resources are currently being reviewed by the education
and public health teams from across Hampshire to decide how best to integrate
them into the school curriculum.
The aim of this quality improvement project was to empower parents and provide reassurance on managing everyday childhood illnesses through workshops delivered by children’s centre staff. A pre-project questionnaire, completed by 85 parents, demonstrated that the reason most parents take their children to the emergency department is to seek reassurance that their child is not seriously unwell. This finding justified the focus on common illnesses in children. The workshops were piloted in Sure Start centres and through feedback and co-design with parents, evolved from a teaching session to an interactive game played by parents and facilitated by health visitors.
Examples of the resources developed include the following:
Flash cards for parents:
Feedback from parents included the following:
‘If I had known this before I wouldn’t have worried’
and ‘It’s good to have people coming into groups to talk to parents about things like that’.
Feedback from the children’s centre staff was that they felt confident to facilitate the sessions.
The full report can be access here (hyperlink to PDF)
Based on this project, we are planning to run a larger study looking at the impact of common illness workshops by primary care staff. This will begin in 2021.
To access and download the full project report, please click here.
When we work with and alongside children and families,
rather than make decisions for them, we deliver far better care. This is the basis
of restorative practice; it is founded on the principles of working ‘with’
people, rather than doing ‘to’ or for others. If done well, it helps to build
trust between families and the organisations which are there to help them, encourages
families and young people to make safe and healthy decisions and decreases
crime and antisocial behaviour.
This project has brought together leaders from various
organisations involved in supporting families, including the NHS, local
government, social services, education and the criminal justice system. By
working together, they can improve the way that services are delivered across
This short video was produced by the Wessex maternity, children and young people clinical network
Clear to watch a video from Wessex Clinical Senate and Networks on Restorative Practice
1) Lees A, Tapson K, Patel S. A qualitative evaluation of parents’ experiences of health literacy information about common childhood conditions. Self Care 2018;9(1)1-15.
This article reports the findings from a
qualitative service evaluation of health literacy resources for parents of
children aged 0-4 on six common paediatric conditions (abdominal pain,
asthma/wheeze, bronchiolitis, diarrhoea/vomiting, fever and head injury). These
have been launched across Wessex as part of the Healthier Together (HT) project
and consist of a website and paper-based resources designed to provide easily
accessible facts about common childhood conditions, advice on actions to take
in the event of certain symptoms and when and where to seek medical help.
Eighteen semi-structured interviews were conducted to investigate parents’
experiences of and reactions to the resources. We investigated perceived
effects on parental understandings and feelings about childhood illness and
help seeking behaviours. We discuss findings under four main headings: Parental
interaction with HT resources, Parents’ anxieties concerning their children’s
health, Positive evaluation and Areas for improvement. Parents positively
evaluated the aims of the project and the information provided. A small number
gave examples of resulting behaviour change and several anticipated future
changes. Parents expressed anxiety about childhood illness and making treatment
decisions. They required simple and easy to navigate resources including
prominent risk assessment information. Communication by health professionals
that reassures and empowers parents was also seen as important. Whilst this was
a small study we believe that the findings are of relevance to others
producing, disseminating and explaining health information aimed at parents and
other patient groups.
2) Fake E, Lees A, Tapson K, Patel S. Parental views on the management of young children with respiratory tract infections in primary care – a pilot study. Self Care 2018;9(4)23-34
Local primary care data shows a 24% increase in the rate of acute
presentations with common self-limiting infections for children aged 0-4 years
between 2015/16 – 2016/17. As rates of serious illness have decreased, this
means increasing numbers of presentations could be managed elsewhere. Although
parents rarely expect antibiotics, they are often perceived to want them by
clinicians; potentially resulting in more antibiotic prescriptions and driving
future health-seeking behaviour.
To explore parent expectations, concerns and opinions about the primary
care management of children presenting with respiratory tract infections
Semi-structured interviews with parents of children aged 0-4 years
presenting to primary care clinicians with symptoms of a respiratory tract
infection. Analysis involved thematic review
Parents used experience or ‘parental instinct’ when deciding to consult;
this was due to seeing a similar illness before and receiving treatment, or
alternatively having never seen this illness and being unsure of what to do.
Parents saw the usefulness of written information describing actions to take
and when to consult when their child was unwell. There was an about even split
between those preferring paper and those preferring web-based resources. All
parents sought input from a clinician for reassurance.
Better understanding of parent expectations when consulting clinicians
with unwell children could facilitate a more effective consultation. Parents
expect reassurance about their child’s illness, but inconsistent advice and
management from healthcare professionals, such as prescribing antibiotics, act
to increase parental anxiety and potentially drives future health-seeking
behaviour. Changing the way clinicians communicate, including the use of
consistent messages, may have a positive impact during current and future acute
3) Donovan E,
Wilcox CR, Patel S, Hay AD, Little P, Willcox ML. Digital interventions for
parents of acutely ill children and their treatment-seeking behaviour: a
systematic review. British Journal of General Practice 2020; 70 (692):
Background Consultations for self-limiting
infections in children are increasing. It has been proposed that digital
technology could be used to enable parents’ decision making in terms of
self-care and treatment seeking.
Aim To evaluate the evidence that digital
interventions facilitate parents deciding whether to self-care or seek
treatment for acute illnesses in children.
Design and setting Systematic review of studies
Method Searches of MEDLINE and EMBASE were made
to identify studies (of any design) published between database inception and
January 2019 that assessed digital interventions for parents of children (from
any healthcare setting) with acute illnesses. The primary outcome of interest
was whether the use of digital interventions reduced the use of urgent care
Results Three studies were included in the
review. They assessed two apps and one website: Children’s On-Call — a US
advice-only app; Should I See a Doctor? — a Dutch self-triage app for any acute
illness; and Strategy for Off-Site Rapid Triage (SORT) for Kids — a US
self-triage website for influenza-like illness. None of the studies involved
parents during intervention development and it was shown that many parents did
not find the two apps easy to use. The sensitivity of self-triage interventions
was 84% for Should I See a Doctor? compared with nurse triage, and 93.3% for
SORT for Kids compared with the need for emergency-department intervention;
however, both had lower specificity (74% and 13%, respectively). None of the
interventions demonstrated reduced use of urgent-care services.
Conclusion There is little evidence to support
the use of digital interventions to help parent and/or carers looking after
children with acute illness. Future research should involve parents during
intervention development, and adequately powered trials are needed to assess
the impact of such interventions on health services and the identification of
children who are seriously ill.
4) Patel S,
Hodgkinson T, Fowler R, Pryde K, Ward R. Integrating acute services for
children and young people across primary and secondary care. British Journal of
General Practice 2020; 70 (693): 158-159.
Children and young people under 18 years of age currently
account for approximately 25% of attendances to primary and secondary care but
only 12% of hospital admissions. The fact that children are the most likely age
group to attend emergency departments unnecessarily suggests that high levels
of parental anxiety is driving health seeking behaviour. This observation
justifies initiatives to deliver integrated acute services for CYP which
achieve consistency across primary and secondary care. Consistent management
and safety-netting by healthcare professionals reduces parental anxiety, which
in turn reduces urgent care presentations by empowering parents to confidently
self-manage minor illnesses. Addressing this avoidable activity would relieve
pressure on our currently overstretched urgent care services, improving access
and quality of care to those who need it most.