NHS Lothian's paediatrics cluster interface model

NHS Lothian has piloted a new cluster interface model in medical paediatrics that has significantly improved referral pathways, reduced referral rates and waiting times alongside enhanced experience for both clinicians and families.

In 2019, increasing pressures on outpatient appointments in medical paediatrics had led to lengthening waiting times and was having a negative impact on patient experience. Against a backdrop of increasing system pressures, siloed working and limited means of collaboration between primary and secondary care, an innovative new approach was needed.

NHS Grampian and the Scottish Government initially co-designed a cluster interface model. This innovative and collaborative approach used data to redesign and improve the outpatient medical paediatrics pathway. 

In this model, each GP cluster (groups of five to ten GP practices in a close geographic location) has a named Specialty Consultant and named GP with an extended role (GPwER) in the Specialty. The two clinicians work together to take all outpatient referrals for that Specialty from that cluster. They triage referrals, with a substantial proportion resolved through advice or telephone consultations. Where face-to-face appointments are required, patients are seen in clinic in the community close to home. 

Clinics typically occur once a month, though this is adjusted based on local/Specialty demand. Patients are seen by either the Consultant or GPwER. GPwER work one session a week or fortnight, which can involve triaging, advice-giving, telephone consultations, monthly clinics and education for the cluster.

Through analysis of referrals, the clinicians are able to find areas for education and training of healthcare staff across the cluster. This learning can take place through a range of modalities including cluster-wide teaching, focused work within individual practices, health visitor teaching and much more.

This new model of care was piloted in a number of clusters in NHS Grampian, then, driven by data, expanded to be used across all of Aberdeen City and Aberdeenshire.

Following this success, NHS Lothian piloted the model from 2022, the results of which have been encouraging. Evaluation shows waiting times reduced by up to 80%, a reduction in Did Not Attend (DNA) rates from 15% to 5%, reduced referral rates, reduced A&E attendances, reduced patient travel and overall increase in positive experiences of the referral pathway for patients and clinicians alike (increasing from 5/10 to over 9.5/10). The success of this work has prompted the expansion of the model across multiple clusters in medical paediatrics. Other specialties within NHS Lothian are in the process of exploring and/or adopting this model.

The complexity of healthcare systems, high numbers of stakeholders and significant service pressures contribute to an organisational inertia that can stifle innovative approaches like the cluster interface model.  Within Lothian, the Lothian Interface Group (LIG) played a key role in supporting the pilot and encouraging the subsequent adoption of the model. 

The project lead was supported by LIG via the co-chair who acted as champion for the project. LIG has co-chairs from primary and secondary care and they were able to offer practical and strategic advice due to in-depth knowledge of service pressures across the system. For example, LIG provided guidance on the potential impact on General Practice workload and how the Lothian GP cluster model could support the work. LIG included the project as a standing agenda item to continually support and ‘sense-check’ the roll out. The project benefitted from high level discussion and 'socialisation' of the work at LIG, who cascaded this information more broadly. This helped build momentum and secure support for the proposal. At the time of writing, the cluster interface model is being rolled out in gynaecology and recruitment is underway for a GPwER in that specialty.

In this initiative, Lothian Interface Group facilitated collaborative work between specialties which has improved the patient journey. Key elements of the work in Lothian include having a shared aim of improving the patient journey and having group members able to act as 'effective effectors', leading and supporting change. This approach demonstrates the potential for Interface Groups to facilitate innovation within a Health Board, leading to better and more efficient patient care.

For more information on this case study, please contact scotland.interface@rcgp.org.uk