Dianne L Cook Community Children

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A service for children in the community with
acute minor illnesses
Dianne L Cook Community Childrens Advanced
Nurse Practitioner
RCN CCN Forum Member
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Content of presentation
Content of presentation

• History of Manchester Childrens Community Team
• How service is currently delivered
• Implementation of Minor illness Drop-in Clinic
• The vision for the future

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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 gt 50 of children living
  in income deprived families.
• The North West remains the region with the
  fewest GPs per head of population

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Changing Patterns of care

• 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 lt 5.
  Childrens Community nurse based in AE to
  re-direct patient flow.

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Changes to Services in Manchester

• Closure Booth Hall Childrens Hospital June
  2009
• Closure Pendlebury Childrens Hospital 2010
• New Central Manchester Childrens Hospital
  2009
• Increased children's community nursing teams to
  provide more hospital at home services

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• Moving services into
• primary care

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• Meeting the needs of the family
• Location
• Time
• Accessible

Does your child have asthma?
Does your child have asthma?
Does your child have Eczema?
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 Childrens Asthma Drop in Clinic On
Thursday afternoons 2pm-4.30pm Harpurhey Sure
Start Childrens Centre Upper Conran
Street Harpurhey Manchester M9 4DA
Tel [phone]
Maybe you can get the help and support you need
at the Childrens Asthma Drop in Clinic On
Thursday afternoons 2pm-4.30pm Harpurhey Sure
Start Childrens Centre Upper Conran
Street Harpurhey Manchester M9 4DA
Tel [phone]
Maybe you can get the help and support you need
at the Childrens 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
childrens community nurses, where parents and
children can just drop in - no appointment is
needed. The clinics are run by trained asthma
nurses. The
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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.

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Case for Change

• Despite the proliferation of alternatives to
  hospital, admission rates
• continue to grow in the Northwest. The public
  continues to access
• AE 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 AE in
  the North West (per
• 1000 population) than anywhere else in England
  except London

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• 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 childrens
  services and the imminent closure of the local
  childrens hospital in Manchester has given the
  CCNT the opportunity to grasp and creatively
  transform the way we deliver some of our
  services.

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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.
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• To provide local access of community provision
  for children and young people particularly in
  light of the closure of the childrens 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 AE or secondary care
  admissions/interventions

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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
  childrens 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.

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Who was involved in the process?

• CCNT Manager
• General Manager/Lead Nurse Childrens Services
• Community Childrens Advanced Nurse Practitioner
• Customer Experience/Clinical Governance
  Facilitator
• Sure Start Head of Centres

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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 2000 on Wednesdays (Most GP
  surgeries closed)
• Advanced Paediatric Nurse Practitioner CCNT
• Continued care by CCNT
• Provision of Care Closer to Home Located
  within two
• Sure Start Childrens Centres in deprived areas
  of Manchester

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Examples of Acute Minor Illnesses
Coughs Colds
Rashes Upper Respiratory Infection
Lower Respiratory Infection Vomiting
Childhood Infectious disease (mumps, measles, chickenpox) Gastroenteritis
Otitis Media Fever
Asthma Eczema
Constipation Tonsillitis
Urinary Tract Infections Conjunctivitis
Soft tissue injuries Muscle strains
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• GPs
• HVs
• Practice Nurses
• School Nurses
• Families/Carers
• Local Supermarkets/Shops
• Childrens Sure Start
• Centres

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• 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.

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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

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• 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

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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
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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 Childrens
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 Childrens 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.
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Impact of the service

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

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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

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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