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Lessons learnt (so far) from establishing models of integrated clinical care for children and young people
  1. Mando Watson1,
  2. Simon Struthers2,
  3. Stephen W Turner3
  1. 1Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
  2. 2Hampshire Hospitals NHS Foundation Trust, Winchester, UK
  3. 3Maternal and Child Division, Department of Child Health, NHS Grampian, Aberdeen, UK
  1. Correspondence to Dr Mando Watson, Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK; mando.watson{at}

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Children’s health needs are changing. Today, infectious diseases cause less morbidity, children are living with complex conditions, and social determinants of health play an ever greater role. Parent health seeking behaviour is changing, leading to less self-care and increased presentation to health professionals. These changes are placing an ever-increasing demand on primary and secondary healthcare. This pressure can be seen in waiting times for children to be seen in clinic; in England, over 400 000 children are on a waiting list, while in Northern Ireland, over 5000 children have been waiting for more than 1 year.1 Scheduled paediatric care in the outpatient department is close to failing our children (if it has not already failed).

The traditional scheduled care model involves a referral from primary care to secondary care—the patient is seen in due course, usually on a hospital site. In this simple pathway, no intervention is made before the child is seen, meaning that symptoms remain untreated and concern accumulates until the appointment. The pathway is restricted to healthcare and does not consider education, public health, social care or the voluntary sector.

In recognition of the limitations of the traditional scheduled care model, new and integrated models of paediatric clinics are emerging across the UK ( and internationally. These new models connect hospital-based paediatric specialists with community-based primary care clinicians; some are multi-professionals and multi-agency—all work across primary and secondary care. They demonstrate efficient delivery of tangible benefits (up to 40% reduction in scheduled specialist care) in addition to parent and GP satisfaction.2–7 We describe three models in box 1. Other UK and international models are described on the RCPCH website and in published literature.

Box 1

Descriptions of three models of integrated care

Model 1—Connecting Care for Children (CC4C)5

Paediatric outpatient clinic time is re-purposed; each paediatrician supports a ‘neighbourhood’—here meaning a group of GP practices—covering a population of 30 000–50 000. …

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  • Twitter @mandowatson

  • Contributors MW and SWT conceived the idea. MW wrote the first draft. All authors made meaningful contributions to the manuscript and have seen and approved the final version. SWT is the guarantor of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.