Table 2

Hypothesised relationship between activities, mechanisms and aims*

Telephone MDTHospital at home
If….GPs, paediatricians and a wider MDT discuss specific children and young people at high risk of ED attendances by phone each monthSpecialist community nurses make daily visits to acutely unwell children and young people at home, followed by a telephone call between the community nurse and duty paediatric consultant
Then….GPs will feel motivated and confident to manage these patients and will gain skills/have access to specialist support to do so (shared responsibility and upskilling GPs)
MDT members will better understand their colleagues and their service thresholds (establish professional relationships and share norms)
Community nurses will have access to specialist paediatric support to manage these patients (shared responsibility)
Community nursing and paediatric team will build relationships, trust and understanding (establish professional relationships and share norms)
So that….Patients receive high quality care from their GP
Families perceive a ‘joined up’ healthcare service and have a better patient experience
GPs refer patients appropriately to ED
Paediatricians and community nurses jointly plan care (take specialist care to the patient)
Community nurses can give parents extra skills and confidence to look after their unwell child
So that…Patients trust the care they receive from the GP, feel motivated to seek help from primary care and become confident in managing their own chronic conditions
Patients experience fewer exacerbations of chronic illness
Parents can look after their child overnight without professional support and can recognise when to seek urgent help
Families experience a ‘joined-up’ healthcare service and a better patient experience
So that…The need and motivation for ED visits is reduced
Hospital costs are reduced and burden on overstretched ED services is eased
Quality of healthcare is maintained
There is less inconvenience and disruption for the patient and family
These children and young people can avoid emergency hospital admissions (along with hospital acquired infections) and if admitted, can be discharged earlier
Hospital admission costs are reduced and beds are freed up
Quality of healthcare is maintained
There is less inconvenience and disruption for the patient and family
GP outreach clinics (London)/paediatric primary care (Taunton)Advice and guidance service
If….If a consultant paediatrician runs a regular outpatient clinic in primary care, either jointly with a GP (London), GP trainee or health visitor (Taunton), or alone (Taunton)If GPs have access to email advice and guidance from a consultant paediatrician when they are considering referring a child or young person to a hospital outpatient clinic
Then….GPs will gain paediatric confidence and expertise, which they can disseminate to their colleagues (joint clinics; upskilling GPs)
GPs, health visitors and paediatricians will better understand each other and the different service thresholds (joint clinics, establish professional relationships and share norms)
GPs will develop paediatric expertise (upskilling GPs)
So that….Patients have access to paediatric examination and expertise closer to their home (Taking specialist care to the patient)
Families perceive a ‘joined up’ healthcare service and have a better patient experience
Families trust the care they receive in the community and are motivated to seek care outside of hospital
GPs can manage more children and young people without referring to hospital services
Families have increased trust and confidence in primary care
So that…These patients do not need to attend a hospital-located outpatient clinic
These patients are less likely to go to ED for healthcare needs
Healthcare costs are reduced and burden on overstretched outpatient and ED services are eased
Quality of healthcare is maintained
There is less inconvenience and disruption for the patient and family
Referrals from GP to hospital outpatient clinics are reduced
These patients are less likely to go to ED for healthcare needs
Healthcare costs are reduced and burden on overstretched outpatient and ED services are eased
Quality of healthcare is maintained
There is less inconvenience and disruption for the patient and family
  • *Formulated as a series of ‘if–then’ statements, following examples of articulating programme theory by Pawson et al7 Common mechanisms (see table 1) are in bold.

  • ED, emergency department; GP, general practitioner; MDT, multidisciplinary team.