Paediatric 'care closer to home': stake-holder views and barriers to implementation.
In this study we explore the views of NHS stakeholders on providing paediatric 'care closer to home' (CCTH), in community-based outpatient clinics delivered by consultants.


METHODS
Semi-structured interviews and thematic framework analysis.


METHODS
UK specialist children's hospital and surrounding primary care trusts.


METHODS
37 NHS stakeholders including healthcare professionals, managers, commissioners and executive team members.


RESULTS
PARTICIPANTS acknowledged that outreach clinics would involve a change in traditional ways of working and that the physical setting of the clinic would influence aspects of professional practice. Different models of CCTH were discussed, as were alternatives for improving access to specialist care. PARTICIPANTS supported CCTH as a good principle for paediatric outpatient services; however the challenges of setting up and maintaining community clinics meant they questioned how far it could be achieved in practice.


CONCLUSIONS
The place of service delivery is both an issue of physical location and professional identity. Policy initiatives which ignore assumptions about place, power and identity are likely to meet with limited success.
School of Health and Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK. g.heath@bham.ac.uk
Gemma
G
Heath
Elaine
E
Cameron
Carole
C
Cummins
Sheila
S
Greenfield
Helen
H
Pattison
Deirdre
D
Kelly
Sabi
S
Redwood
D000553:Ambulatory Care; D002648:Child; D002662:Child Health Services; D003153:Community Health Services; D004739:England; D006297:Health Services Accessibility; D006801:Humans; D016730:Program Development; D036301:Qualitative Research; D013222:State Medicine