6828 Good things come to those who wait – Not always!

Objectives The demand on paediatric outpatient services is increasing, with waiting lists longer than ever. Our General Paediatric waiting time has increased from 16 weeks to nearly 40 weeks in the past 2 years. Our aims Reduce pressure on paediatric referrals by joint working between GP practices and local hospital. Maintain high-quality paediatric care, delivered in a timelier manner, closer to home. Reduce referrals long-term by increasing GP confidence in managing paediatric patients. Methods We adapted the London 'Learning Together1 2' model in Milton Keynes and partnered with two local GP surgeries to establish collaborative Paediatric-GP outreach clinics. We held seven clinic sessions over 3 months, each conducted jointly by a Paediatric Registrar and GP Registrar. Children with presenting problem likely to need a paediatric referral were chosen. Each consultation was 20 min with 10 minutes for discussion and feedback. Clinics were jointly supervised by GP Trainer and a Consultant Paediatrician. Basic patient demographics were collected, along with presenting complaint, diagnosis, and consultation outcomes. Feedback forms were given to all parents, along with children aged 4 years or older. Participating trainees completed feedback before and after the pilot. Results Over seven clinic sessions, thirty-two children were seen (M:F= 56%:44%) and the mean age was 8.2 years (range 7 months – 17 years). Common presenting complaints were allergy (28%), abdominal pain (16%), and respiratory concerns (16%). The most frequent diagnoses were allergy (19%), constipation (19%), and well children (16%). The majority (60%) of patients were discharged with reassurance and 22% booked for planned GP follow-up. One child was referred to paediatric outpatient clinic. In summary twenty-one paediatric outpatient referrals were avoided. 25 parents and 21 children completed feedback forms. All parents rated the joint consultation as Excellent (80%) or Good. They rated Much better (76%) or Better than being seen in hospital. All parents felt the doctors worked well together. 86% of children felt positive about their visit to the doctor, and 81% would be happy to see two doctors again. Trainees' felt their knowledge and confidence increased. Trainees particularly valued working together and sharing knowledge. Conclusion We successfully piloted Paediatric-GP outreach clinics. A significant number of paediatric outpatient referrals were avoided. We demonstrated high levels of patient and parent satisfaction. Trainees involved showed excellent learning outcomes in a highly valued training environment. This model of patient care is locally implementable, builds strong primary-secondary care relationships, and reduces pressure on hospital waiting lists. References http://www.learningtogether.org.uk/ Macaulay C, Riches W, Spicer J, Lakhanpaul M. Learning Together: local integrated child health, July 2014.