Dianne L Cook Community Children’s Advanced Nurse Practitioner

1. A service for children in the community with acute minor illnesses Dianne L Cook Community Children’s Advanced Nurse Practitioner RCN CCN Forum Member

2. Content of presentation Content of presentation • History of Manchester Children’s Community Team • How service is currently delivered • Implementation of Minor illness Drop-in Clinic • The vision for the future

3. Population & Demographics • 458,136 registered population – 24.3% children 0 -19 • Manchester birth rate is predicted to rise in the 0 - 4yr from 29.9 thousand in 2008 to 32.1 thousand by 2014. • Infant mortality 8.2% (national average 5.1%) • 14 wards in Manchester > 50% of children living in income deprived families. • The North West remains the region with the fewest GPs per head of population

4. 1984 Service started predominately GP referrals for acute conditions 1986 - 1992 Caseload more children with chronic conditions often with acute exacerbation – Service expanded with more specialist nurses (Asthma, Diabetes & Cystic Fibrosis) 1993 - Present Increased attendances at A &E for minor illnesses – GP referrals to service < 5%. Children’s Community nurse based in A&E to re-direct patient flow. Changing Patterns of care

5. Changes to Services in Manchester • Closure Booth Hall Children’s Hospital June 2009 • Closure Pendlebury Children’s Hospital 2010 • New Central Manchester Children’s Hospital 2009 • Increased children's community nursing teams to provide more “hospital at home” services

6. Moving services into • primary care:

7. Meeting the needs of the family: • Location • Time • Accessible Does your child have Eczema? Does your child have asthma? Does your child have asthma? Would you like information about asthma, symptoms, trigger factors and treatments? Do you need help or advice using your inhaler? Would you like information about asthma, symptoms, trigger factors and treatments? Do you need help or advice using your inhaler? Would you like information about Eczema, symptoms, triggers and treatments? Do you need help or advice with your medications? Maybe you can get the help and support you need at the: Children’s Asthma Drop in Clinic On Thursday afternoons 2pm-4.30pm Harpurhey Sure Start Children’s Centre Upper Conran Street Harpurhey Manchester M9 4DA Tel: 0161 277 1930 Maybe you can get the help and support you need at the: Children’s Asthma Drop in Clinic On Thursday afternoons 2pm-4.30pm Harpurhey Sure Start Children’s Centre Upper Conran Street Harpurhey Manchester M9 4DA Tel: 0161 277 1930 Maybe you can get the help and support you need at the: Children’s Eczema Drop in Clinic On Wednesday mornings 10am-12pm At Longsight Health Centre 526/528 Stockport Road Longsight Tel: 0161 248 8501 The drop in clinic is a weekly clinic where parents and children can just ‘drop in’ - no appointment is needed. The clinics are run by trained asthma nurses. The The drop in clinic is a weekly clinic where parents and children can just ‘drop in’ - no appointment is needed. The clinics are run by trained asthma nurses. The The drop in clinic is a weekly clinic, run by children’s community nurses, where parents and children can just ‘drop in’ - no appointment is needed. The clinics are run by trained asthma nurses. The

8. Case for Change • Around 3.5 million children per year attend emergency departments in the UK (Royal College of Paediatrics and Child Health 2007), equating to around 28% of the child population each year. • About 90% of these children attending an emergency department will be seen with acute minor illnesses and discharged without involvement of any in-patient team. • The 0-4 year age group consults more often than any other group except the elderly (Royal College of Paediatrics & Child Health 2007). Acute childhood illness constitutes a high proportion of these consultations.

9. Case for Change • Despite the proliferation of alternatives to hospital, admission rates • continue to grow in the Northwest. The public continues to access • A&E departments for care and treatment of minor and moderate • Illness because the alternatives are not accessible when the public • wants or needs to access them. • In fact, in 2006/07 more people attended A&E in the North West (per • 1000 population) than anywhere else in England except London

10. The Darzi Report (2008) stressing the need for services to: • Extend patient choice by providing convenient ‘Care Closer to Home’ • Working in partnership with local authorities and staff • Provide high quality evidenced-based care • The positive reconfiguration of children’s services and the imminent closure of the local children’s hospital in Manchester has given the CCNT the opportunity to ‘grasp’ and creatively transform the way we deliver some of our services.

11. The drivers in line with ‘Transforming Community Services’ (2009) were for a modern, innovative community service that would have direct benefits for children and young people, and responsive to local need, and promote seamless care through increased opportunities for integration of health and social care services. The aim/goal of the drop-in clinic would therefore be to enable all children and young people in Manchester with acute minor illnesses, to have access to evidence based, high quality paediatric nurse-led community care.

12. To provide local access of community provision for children and young people particularly in light of the closure of the children’s hospital • To develop a means for some services (both NHS and Manchester • Council) to access hard to reach populations and therefore reducing • health inequalities • To develop and achieve more coherent, seamless and integrated • services for children and young people with acute minor illnesses • To promote a single/first point of contact for the child and their family • thus providing primary prevention and early intervention • To promote cost savings to PCT by improving access and potentially • preventing unnecessary A&E or secondary care admissions/interventions

13. Drop-in Clinic development process • How was the idea arrived at? • Impact on Community/Primary Care Services in the north of Manchester on closure of the local children’s hospital – CCNT ANP University places funded • Recognition that already existing CCNT clinics are an effective means to enable parents/carers to access care. Therefore, with the introduction of a new advanced role, clinics would now be able to see undiagnosed acute minor illnesses. • Results from an audit undertaken by the service to establish whether unnecessary/inappropriate referrals from Primary/Community Care were attending Secondary Care.

14. Who was involved in the process? • CCNT Manager • General Manager/Lead Nurse Children’s Services • Community Children’s Advanced Nurse Practitioner • Customer Experience/Clinical Governance Facilitator • Sure Start Head of Centres

15. Key Features of the Drop-in Clinic • Nurse-Led • Drop-in Clinic (No referral required) • Access open to all children (not just those resident in Manchester) • Available 4 days a week • Open until 20:00 on Wednesday’s (Most GP surgeries closed) • Advanced Paediatric Nurse Practitioner – CCNT • Continued care by CCNT • Provision of Care Closer to Home – Located within two • Sure Start Children’s Centres in deprived areas of Manchester

16. Examples of Acute Minor Illnesses

17. GPs • HVs • Practice Nurses • School Nurses • Families/Carers • Local Supermarkets/Shops • Children’s Sure Start Centres

18. Number of Patients attending CCNT Minor Illness Clinic (July-December 2008) 83 66 64 41 27 18 July August September October November December

21. To put patients and their families at the centre of decision making and to ensure that future CCNT services were designed around their personalised needs: • To understand their experiences, expectations and standards: • To drive up the quality of our CCNT service: • A patient survey was sent out by post to a random selection of 150 patients that had used the clinic during the pilot period. • A total of 41 (27%) responses were received.

24. Feedback back from Parents/Carers • ‘Excellent. My six month old boy was sick. I would have to wait 4 days to see GP. Got to see nurse straight away. Only waited 5 minutes. Great service’ • ‘The clinic should be made permanent as I feel more comfortable seeing the nurse than taking my child to see my GP’ ‘The service I got was very good, my daughter was checked over properly, my mind was put at rest, if the clinic wasn't opened I don't know what I would have done as my doctors was full so they wouldn't see me. I really hope these clinics stay open. I always recommend them to friends and family for their children’

25. ‘This is a fantastic convenient service. You can attend at a time that's convenient to yourself and your child. The nurse is experienced with paediatric problems unlike some (or most) GPs’ • ‘Very handy service! Would relieve the work on GPs and waiting times’ ‘The only problem I found was the nurse could not prescribe so had to wait a few days for the doctor to do it’

26. Comments and Feedback from Head of Centres ‘Service provided has been invaluable to our families’ ‘The clinics enabled working parents who were unable to get an appointment outside working hours’ ‘The nursery at the centre got consent forms pre-signed by parents to enable nursery staff to take a child to see the nurse, thus avoiding the need for parents to leave work’ ‘Working within the Sure Start centres enables signposting to all the services on offer. There are multi-agencies on site such as: Midwives, Health Support, CAPS, SALT and Education; and we all work together in safeguarding children’

27. Comments and Feedback from Head of Centres ‘We feel that it would be beneficial in the future to develop this further, thus enabling us to work in partnership with the Children’s Community Nursing Team to provide a quality service for our families. Some of whom are hard to reach and more vulnerable.’ ‘The provision of these Children’s drop-in clinics is vital in providing additional medical care, as the Childcare Act (2006) placed a duty on local authorities along with their partners, e.g. Health and PCT ‘to improve the well-being of all young children in their area and reduce inequalities between them.’

28. Impact of the service • Local access of community provision for children and young • people, particularly in light of the imminent closure of the children’s • hospital • Development and achievement of a more coherent, seamless and • integrated service for children and young people with acute minor • illnesses • Appropriately qualified expert children’s nurse practitioners seeing • children and young people • A single/first point of contact for the child and their family

29. Impact of the Service • Promotion and implementation of evidenced based nursing care • The innovation has been an enhancement of services already being • provided i.e. General Practice and therefore was promoted as not • a replacement but as an alternative service for parents/carers to • choose access • Collaboration and communication with Manchester City Council • Cost savings to PCT due to prevention of unnecessary secondary • care admissions/interventions

30. Vision for the future • Service development business proposal submitted • 1 x afternoon drop-in clinic commenced within a health centre • (awaiting further funding to extend across the city) • V300 Non-Medical Prescribing course commenced