Together clinics bring paediatric care close to home

Special paediatric clinics held in GP practices across Wandsworth are transforming children’s healthcare. Children are seen by a consultant and their GP – Together – speeding up treatment, reducing follow-up appointments and keeping care close to home.

“This really is a great service,” says Dr Tom Coffey, lead GP for children’s services in Wandsworth, “and the result of some genuine collaboration that brings the specialist close to the patient.”

A genuine partnership between primary and secondary care

The clinics were developed by Tom and Dr Marianne Leach, paediatric consultant at St George’s University Hospital. Says Marianne “The Together clinics reflect a genuine partnership between primary and secondary care. They improve children’s health and their experiences of paediatric care. It is not about transferring an outpatient clinic from the hospital to a different location. Instead, we are building relationships and breaking down silo working. I am passionate about developing these further.”

The first Together clinic launched in 2017 as a pilot in Putneymead surgery. From that one base, the team upscaled to three locations, then to six. By July there will be seven Together hubs serving nine primary care network areas, with five acute paediatric consultants delivering the clinics.

Patients are seen for the same conditions as in the general acute paediatric clinics at St George’s

GPs can book children from birth to 18 directly into the clinic. Patients are seen for the same conditions as in the general acute paediatric clinics at St George’s – everything from reflux, weight and concern about head shape in babies, to headaches or abdominal pain in older children.

For non-emergencies, children are usually seen at the Together clinic within four weeks of first consulting their GP. Appointments take place in their own practice or one nearby. This means the whole process is speedier than the traditional route. In urgent cases, children are referred for further investigations within days and GP involvement means follow-up appointments can take place at the surgery without waiting for an outpatient slot.

Being able to come to our local GP and see a consultant has been absolutely amazing

Jennie Rankin attended the Together clinic at Earlsfield Practice with her daughter Grace, aged seven months. Grace has experienced health problems since contracting viral meningitis when she was three weeks old.

Jennie said: “We’ve had two admissions to St George’s hospital with bronchiolitis, which is why we saw the paediatrician today. It has been quite stressful and quite scary but being able to come to our local GP and see a consultant, who we’ve dealt with before at St George’s has been absolutely amazing. We haven’t had to wait months. 

“The GPs at Earlsfield have been amazing too. When you are a mum with a very ill baby it’s great that you can access that extra expertise. Today we went in to get Grace’s breathing checked and a list of other things. Everything was dealt with really well. We’ve got a plan of action and a follow-up in four weeks, so it’s been very positive.”

Patients are also discussed in multi-disciplinary team meetings, either virtually or in-person, twice a month. These involve consultants, GPs and practice nurses, with long-term plans to include health visitors, therapists and other professionals who work with children and young people. The meetings mean some children can be managed by the GP without attending the clinic.

This is one of the best changes I’ve seen in general practice

Dr Khalida Salim of the the Earlsfield Practice takes part in Together clinics with Marianne. She said: “This is one of the best changes I’ve seen in general practice over the past few years. It breaks down barriers. Before, just to reach a paediatrician or a consultant at the hospital took a lot of time. Now we just write a short email, asking ‘what advice do you give?’, making it so much easier for us.”

According to Khalida the clinics have been instrumental in upskilling GPs. “There are specific pathways, for suspected migraine headaches, for example, which a paediatrician will follow. I’m learning about these, and about which investigations are needed. And I apply it, so now I don’t need to refer as many children as when we started the clinic.”

As paediatricians we also learn a lot too

While GPs are learning about areas of child health they might not normally encounter, Marianne stresses that consultants are not coming in as ‘the specialists’. “It’s not only the GPs who are learning. As paediatricians we also learn a lot too. And the trust which develops helps to provide better care for the children and young people. As one of the GP partners in a Together clinic said to me ‘this is how medicine should be’.”

As for the families? “They all love it,” Marianne says. “I recently saw a patient from the Together clinic in hospital for another reason. He said, ‘Oh can’t you see me with the GP?’

“Children like the clinics because they’re in a familiar environment, parents like them because they don’t have to go to the hospital and GPs and paediatricians love them because they are more efficient, faster and, so much better for the patient.”