Open Access project for children with congenital issues and complex medical needs

Dr Tahir Mehmood

An introduction to the practice
Biscot Group Practice is an urban practice with an increasing list size, currently 12,200 patients and the majority of patients are of South Asian origin. Our trainee practice, Blenheim Medical Centre, is based in Luton Bedfordshire, an area of high deprivation; the number of children on our list significantly exceeds the national average. Historically South Asian patients have different health seeking behaviour and attend their GP more times per patient per year than any other ethnicity group. A large proportion of the outpatient list consists of children. We have a significant number of children born with congenital abnormalities and complex health needs. Because of the large number of children on our list the risk adverse behaviour of parents mean that they require frequent appointments.

The problem
All the above have resulted in a massive access problem for the practice which has long been a significant issue for us. This has affected patient perception of our practice as a whole, as reflected in National Survey, and resulted in a negative picture of the practice. Many of the children mentioned above had open access to the paediatric department at the local hospital and it was found that many of these patients were attending frequently even though it was inappropriate because they found it quicker and easier than seeing a GP. This was inconvenient for the families of these children and resulted in no clear care plan and no continuity of care. It also put more strain on local paediatric and emergency services available.

How did we tackle it?
Our first step was to hold a practice “think tank” meeting which was attended by key members of staff from every area of the practice – receptionists to partners. We looked at all the feedback from patients including previous years’ survey results, complaints & feedback which led us to hold few brainstorming sessions for solutions. By the end of our meetings we were all in agreement that the preferred solution would be to grant “Open Access” to all children with congenital problems/complex needs and patients with learning disabilities. Our next step would be to find out from our patients if this service would help them.

How did we start?blenheim-medical-practice
Firstly, we identified the children with congenital problems and complex medical needs. We invited more than a few dozen families/guardians  of these children to attend an informal lunchtime meeting at the practice. These agenda led meetings were facilitated by Dr Tahir Mehmood, a Partner at the practice, and Kelly Walton, our Reception Manager. The purpose of the meeting was to identify the expectations of families of these children from their home practice and to introduce our idea of “open access”. The idea of open access became hugely popular as it seemed to fulfil their needs. It was agreed that the practice would actively involve families to formulate an improvement plan using feedback and that the group would reconvene at a later date to present the plan and to agree timescales for implementation.

At the follow up meetings, the practice “Think Tank” met again to discuss how to proceed with the demand of open access for these children and how to incorporate other suggestions from the parents group. We decided that the parents of these children could call the practice at any time, they would not have to make an appointment and would be guaranteed to be seen by a GP within 2 hours or they could walk in to the practice at any time and would be given priority i.e. they would be seen as soon as a GP became available. In response to a suggestion from some of the parents we decided that in the case where a parent did not want to sit in the waiting room with other patients or where the child was very ill and there was risk of further infection we would seat them in a separate area.

After running this project for a few months, we held a joint meeting with parents and families and invited the Paediatric Rapid Response Team. The meeting was eagerly joined by the representative from the paediatric unit at Luton &Dunstable NHS Foundation Hospital. During this meeting we presented our plans which were complimented by the service users and joint committee. We agreed to continue to provide open access to the families of children with complex health needs for an indefinite period. We also decided to review the size of the list on regular basis.

Results

  • The Rapid Response Team report that the number of children arriving for open access to the wards has reduced significantly.
  • Anecdotally, parents are very happy with the service and their overall satisfaction with the practice has increased.
  • Continuity of care has improved and GPs report improved relationships with the families of these children.
  • Our local CCG feels that this is a good example of best practice, good clinical care and compassion to service users and is planning to roll out the same strategy across the Luton area. To date three other practices have implemented the idea.
  • The parents have been motivated to set up their own support network, 'Parents of children with complex needs network'. They have decided to meet frequently to provide help, support and advice to each other and Dr Mehmood has agreed to attend the meetings to facilitate. They have been given the details of our reception manager as a contact if they need any support from the practice. The practice has agreed to provide our meeting room for the group to hold their meetings.

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