A Better Start

Connecting GP’s with children at risk of poor health outcomes

A Better Start
  • Authors: Rachael Kilner, LEAP GP, and Charmain Blake-Senior, LEAP Health Visitor, Guy’s and St Thomas’ NHS Foundation Trust
  • A system for local GPs to proactively reach out to children at risk of poor health has been developed in Lambeth.
Rachael Kilner LEAP GP, Claire Spencer LEAP Midwife at GSTT, Carla Stanke LEAP Public Health Specialist, Charmain Blake-Senior LEAP Health Visitor at GSTT, Octavia Wiseman LEAP Midwife at KCH

LEAP developed the GP Connect project to proactively identify LEAP children at risk of poor outcomes, so early help can be offered to these families. Families and children with complex needs often have many supportive services in place, but those families sitting below this threshold may not be identified until problems escalate and their children are thought to be ‘at risk.’

The project aimed to identify these children via a computer search of codes on their GP notes. The intervention involved a tailored discussion between the family’s GP and Health Visitor (HV) to share knowledge about the family, assess their needs in more detail, and decide on an action plan of support. To promote sustainability after the A Better Start programme finishes, we used services already in place in Lambeth e.g. GP services, health visiting services and early years services.

A review of the literature was carried out to identify possible risk factors that may identify children at risk. However, many of these factors were not coded in GP notes, and there were administration issues of incomplete and incorrect coding.

A ‘late for immunisations’ code could however be searched for easily, and we wanted to investigate whether this could be used as a proxy indicator for identifying further childhood risk factors.

Engagement with GPs and HVs and their managers was achieved by attending both management and clinician meetings to discuss the project. Individual visits to each of the 17 GP practices in the LEAP area were also arranged, with the local children’s centre manager attending in order to increase knowledge and signposting by GPs to council-led children’s services.

Seven LEAP-area GP practices expressed interest in participating in the pilot for six months. Practices performed a search to identify all children aged 0-3 in the LEAP postcode areas, who were three months or more late for any of their childhood immunisations. Twenty children in total were discussed at the GP and health visitor meetings over a six month pilot period. GP Connect was based on the 4-6 weekly GP and health visitor monthly meetings which worked well for some, but not all, practices.

A bespoke template was created to capture risk factors and record them in one place. Some of these risk factors have been identified as being associated with Adverse Childhood Experiences. Information to be gathered included: number of accident and emergency visits; non-attendance at a hospital paediatric outpatient appointment; child protection register entries for child and any siblings; parental history of learning disability or alcohol/drug use, mental health issues or domestic violence; council housing as a proxy for possible poverty; at risk of social isolation; and positive family relationships.

A specific plan of action was then created and recorded. Possible actions included reminding the parents about immunisation or the health visitor or GP review, referral to paediatrician, referral to alcohol/drug services or to domestic violence support, referral to a children’s centre or referral to council early help assessment services. Participating GP practices were paid for time spent doing searches and filling in the bespoke templates.

The project will be evaluated in two ways: an anonymous electronic survey for all staff involved in the project to obtain views about the usefulness of this approach; and by an anonymised questionnaire and submission of anonymised templates asking about action plans for a small number of children. This will allow the study team a deeper level of understanding about whether the template helped to facilitate an appropriate action plan for each child.

We hope this pilot will encourage GPs to think about risk factors for poor outcomes in children and families, and signpost them to early help services and children’s centres sooner. This may enable families to use existing preventative and support services more often, and may reduce the use of inappropriate services such as A&E. The GP and health visitor working relationship may be improved by encouraging regular face to face meetings and better understanding of each other’s roles. Ultimately, the improved GP/ health visitor relationship should benefit families by increasing joined up care across specialities, thereby supporting children before risk factors escalate.

About A Better Start

A Better Start is a ten-year (2015-2025), £215 million programme set-up by The National Lottery Community Fund, the largest funder of community activity in the UK. Five A Better Start partnerships based in Blackpool, Bradford, Lambeth, Nottingham and Southend are supporting families to give their babies and very young children the best possible start in life. Working with local parents, the A Better Start partnerships are developing and testing ways to improve their children’s diet and nutrition, social and emotional development, and speech, language and communication.

The work of the programme is grounded in scientific evidence and research. A Better Start is place-based and enabling systems change. It aims to improve the way that organisations work together and with families to shift attitudes and spending towards preventing problems that can start in early life. It is one of five major programmes set up by The National Lottery Community Fund to test and learn from new approaches to designing services which aim to make people’s lives healthier and happier

The National Children’s Bureau is coordinating an ambitious programme of shared learning for A Better Start, disseminating the partnerships’ experiences in creating innovative services far and wide, so that others working in early childhood development or place-based systems change can benefit.

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