G128(P) Advanced paediatric nurse practitioner (APNP) in primary care (PC) reduced referral proportion by up to 40%

Abstract

Aims As morbidity is decreasing referrals to secondary care are increasing. New ways of working are needed. We trained an APNP who worked in a general paediatric department for 7 years and then went to a referring PC practice. We wanted to see if this altered the referral pattern from PC. Method The APNP recruited to the paediatric department of a medium sized District General Hospital (DGH) and trained by Northumbria University as an APNP. After successful completion of this she worked for 7 years in the DGH’s paediatric department. In April 2017 she moved to the PC practice. She retained the support of her mentor, a consultant paediatrician, at the DGH. Acute and outpatient referrals were compared for the year before she started working at the PC practice and the year after. Results In the year April 2016 – 17 there were 213 referrals. 123 of these were acute and 98 outpatient. There were a total of 2298 child consultations. 9.3% of consultations led to referral. From May 2017 to April 2018 there were 220 referrals. 58 of these were as outpatients. There were a total of 3393 child consultations. Referrals made up 6.5% of consultations. In summary there was a 40% reduction in the absolute number of outpatient referrals, 1/3 lower total referral rate and 48% more consultations. Conclusions The introduction of this APNP reduced outpatient and total referrals after one year. It is possible this will increase as new guidelines and ways of working are introduced into the practice. The improvement does not necessarily mean that all APNPs will have the same effect. We believe the particularly important aspects of this model of care are: a keen APNP, a willingness of all clinicians to work across secondary and primary care boundaries, a supportive mentor/mentee relationship and working in the referral DGH before moving. More work is needed to see if the model is sustainable and can be replicated in other areas.