How to run an effective paediatric rapid referral service

Abstract

Avoiding emergency hospital admissions is a major concern for the National Health Service (NHS). There are two main reasons for this: provision of unscheduled care may limit the ability of a service to provide elective health care (outpatient services) and the high and rising unit costs of emergency admission compared with other forms of care. Costs are higher due to the requirement for services to be safe, predominantly consultant-delivered and be available 24 hours per day, 7 day per week (Audit Commission 2009). Despite considerable efforts to reduce emergency admissions only a minority of primary care trusts (PCTs), now clinical commissioning groups (CCGs) have succeeded in doing so historically. Between 2007/8 and 2008/9 the average increase in admissions was 5% across all PCTs, ranging from a 12.7% decrease to a 27.3% increase. In order to successfully reduce avoidable emergency admissions, it is important to fully understand which interventions are the most effective. Recommendations for reconfiguration of secondary care (hospital based) child health services should be led by clinical priorities e such as clinical guidance, safeguarding, advice to educational services, parental expectation. However these are increasingly influenced by manpower issues such as the implementation of the European working time regulation (EWTR) for trainee doctors and more recently the availability of suitably skilled clinical staff. The need for consultant-led services, demand for service and staff development, current training delivery and expectations for medical, nursing and professionals allied to medicine, and finally the financial imperatives, all operate to influence the types of services we are able to provide. Changes in the configuration of children’s services in the last 25 years have resulted in many different models of care e but common to all is the need for children to be seen by the right person, at the right time, and in the right place, in order to deliver the best outcome.