G293(P) Does every child referred to paediatric out patients need to be seen?

Abstract

Aims In the UK, the referral rate from primary care to General Paediatrics has drastically increased from from 15.5 to 25.7/1000 children per annum1. A Cochrane review identified that ‘local educational interventions involving secondary care specialists and structured referral guidelines are the only interventions shown to negatively impact referral rates’2. This study investigated whether written dialogue with GPs could empower them to appropriately manage potential General Paediatric out patient referrals in the community. Method A retrospective case note review of 300 referrals which were managed with individualised advice letters rather than outpatient appointments between October 2012 and March 2014 was conducted. Results All children under the age of 1 were offered outpatient appointments. The distribution of age groups is illustrated in Figure 1. The system based referrals are demonstrated in Table 1. 84% (n = 253) of referrals were managed by a single advice letter. Within this group, only 26% (n = 66) were re directed to more appropriate services. Of the remaining 47 referrals, 38% (n = 18) were offered outpatient appointments after further telephone discussion with the GP; 57% (n = 27) were re referred after the GP received the advice letter. Of the patients offered out patient appointments, 40% (n = 19) were discharged after the initial consultation and 4% (n = 2) did not attend. No adverse outcomes were noted. Conclusion This study demonstrates that through supporting GP colleagues, selected outpatient referrals can be appropriately managed in the community. In our trust 253 new General Paediatric appointments would represent 41 General Paediatric clinics. However the ‘Payment by Result’ offers perverse financial incentive to manage more patients in secondary care. If adopted regionally this approach would improve patient care in the community and free up Consultant time towards consultant delivered acute care.