title: Child Health General Practice Hubs: a service evaluation.
abstract: OBJECTIVE
  To evaluate the impact of an integrated child health system.
  
  
  METHODS
  Mixed methods service evaluation.
  
  
  METHODS
  Children, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form 'hubs'.
  
  
  METHODS
  Hospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an 'Inside-Out' change known as 'Connecting Care For Children (CC4C)'.
  
  
  METHODS
  Cases seen in clinic or discussed at MDT meetings and their follow-up needs. Hospital Episode data: outpatient and inpatient activity and A&E attendance. Patient-reported experience measures and professionals' feedback.
  
  
  RESULTS
  In one hub, 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice. In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions and a 22% decrease in A&E attenders. Smaller hubs running at lower capacity in early stages of implementation had less impact on hospital activity. Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP and all respondents said they would recommend the service to family and friends. Professionals valued the improvement in knowledge and learning and, most significantly, the development of trust and collaboration.
  
  
  CONCLUSIONS
  Child Health GP Hubs increase the connections between secondary and primary care, reduce secondary care usage and receive high patient satisfaction ratings while providing learning for professionals.
authors.affiliation: Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Montgomery-Taylor
authors.affiliation: Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Mando
authors.initials: M
authors.lastname: Watson
authors.affiliation: Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Klaber
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005260:Female; D058006:General Practice / Q000379:methods*; D058005:General Practitioners; D006801:Humans; D007223:Infant; D008297:Male; D017060:Patient Satisfaction; D010372:Pediatrics; D036301:Qualitative Research; D012017:Referral and Consultation
keywords: General Paediatrics; Health services research; Multidisciplinary team-care; Outcomes research; Qualitative research