6770 Strengthening the links between primary and secondary care: an ergonomic work system analysis for improving children’s health in Birmingham

Objectives Studies have shown that strong links between primary care GPs (General Practitioners) and secondary care providers (Paediatricians) are essential for delivering high- quality paediatric care,1 2 particularly in low-income areas.3 4 At Birmingham Women's and Children's Hospital (BWCH) a new pilot scheme, the 'Canal Project,' was launched in October 2022 to improve these links by implementing paediatric clinics within local GP practices. However, since launching Canal, the project has experienced lower-than-expected levels of uptake from primary care partners. Using a systems approach, this study aimed to map and evaluate the Canal project, to better understand the interactions, barriers, and facilitators to uptake. Methods A key aspect of this aim was to identify and compare the perspectives of primary and secondary care stakeholders. The results were derived from interviews with primary and secondary care staff using the Systems Engineering Initiative for Patient Safety (SEIPS) framework, surveys completed by GPs and patients/families, and an onsite Contextual Inquiry (CI) with a consultant paediatrician. In total, 61 participants took part, representing multiple clinical roles, senior leadership, admin staff and patients/families. Thematic Analysis (TA) was used to identify prominent themes in the data. Results The work system configuration for both pathways were compared to extract the common themes (figure 1). The results identified four main barriers and three key facilitators to the Canal project from, both, primary and secondary care perspectives. The barriers centred around the lack of cross system integration, the communication pathways, the primary care engagement, and the uncertainty over permanency. The facilitating themes were those of strong leadership, effective information sharing and the patient centric focus. Conclusion The results have important implications for the design of paediatric outreach clinics and offer practical recommendations for bridging the gap between primary and secondary care in future integrated care initiatives. They reflect common pitfalls in the design of such pathways which can be key considerations when embarking on similar integration as will be the focus of the newly formed integrated care boards (ICB). We hope to use this information to target the key areas from the thematic analysis during the next phase of the Canal project. References Hodgson HS, Webb N, Diskin L. Consultant-led triage of paediatric hospital referrals: a service evaluation. BMJ Paediatrics Open, 2021;5(1). Kozlowska O, Lumb A, Tan GD, Rea R. Barriers and facilitators to integrating primary and specialist healthcare in the United Kingdom: a narrative literature review. Future Healthcare Journal, 2018;5(1):64–80. Spencer NJ. Consultant paediatric outreach clinics--a practical step in integration. Archives of Disease in Childhood, 1993;68(4):496–500. Maile EJ, Singh R, Black GB, Blair M, Hargreaves DS. Back to the future? Lessons from the history of integrated child health services in England. Future Healthcare Journal, 2022;9(2):183–187.