Table 1

Out-of-hospital (OOH) models of care assessed in this study

ModelDescriptorSiteHours /daysAgeSegmentsInvestigationsManagementClinician expertiseObs facilities?Health education
Current primary care
 Community pharmacyCommunity pharmacy with pharmacists providing walk-in care for basic illness and minor injuriesCommunity pharmacyTo 19:00
Monday–Saturday
10:00–16:00 Sunday
0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

  4. Injury

NilReassurance
Health education
Oral rehydration
Antipyretic
Analgesia
Bronchodilator inhaler
PharmacistNoYes
 Standard GP practiceGP practice offering appointments during standard working hoursGP practiceTo 18:30
Monday–Friday
To 12:30
Saturday
0–17.9y
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

Basic Ix
Basic lab Ix 48 hours
Micro 48 hours
All excluding:
Minor injury
NG or IV fluids
Inpatient Rx
Resuscitation
GPs
Practice nurse
NoYes
Enhanced primary care
 Enhanced GP practiceGP practice with extended hours, walk-in opportunities; regular visits/contact with paediatrician (available within 48 hours)GP practiceTo 22:00 
7 days
0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

Basic Ix
Basic lab Ix 48 hours
Micro 48 hours
All excluding:
Minor injury
NG or IV fluids
Inpatient Rx
Resuscitation
GPs
Practice nurse
Paediatrician 48 hours
NoYes
 GP confederation CYP serviceAPNPs and GPs working within GP confederation with extended hours: coverage includes minor injuries plus illness; regular visits/contact with paediatrician (available within 48 hours). No facilities for observation.GP practiceTo 22:00
7 days
0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

  4. Injury

Basic Ix
Basic lab Ix 48 hours
Micro 48 hours
All excluding:
NG or IV fluids
Inpatient Rx
Resuscitation
GPs
APNPs
Paediatrician 48 hours
NoYes
Enhanced illness assessment and management models
 Nurse-led acute illness team for CYPAPNP appointment-only service, using strict algorithms to manage a very limited set of common illnessesGP practiceTo 20:00 7 days6 months to 17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

Basic Ix
Basic lab Ix 48 hours
Micro 48 hours
Reassurance
Health education
Oral rehydration
Oral antibiotic
Antipyretic
Analgesia
Bronchodilator inhaler
Oral steroids
APNPNoLimited
 Walk-in nurse-led centre for illness in CYPWalk-in centre with APNPs using algorithms to manage a limited set of common illnessesCommunity centreTo 22:00 7 days0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

Basic Ix
Basic lab Ix 48 hours
Micro 48 hours
Reassurance
Health education
Oral rehydration
Oral antibiotic
Antipyretic
Analgesia
Bronchodilator Inhaler
Oral steroids
APNPYes <6 hoursLimited
 Multispecialty community provider for CYPMCP providing appointment-only service focused on illness, including nurses, GPs and daily paediatrician input. Broad range of illnesses treated.GP practiceTo 20:00 7 days0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

Basic Ix
Basic lab IX 48 hours
Micro 48 hours
XR and US 48 hours
Reassurance
Health education
Oral rehydration
Oral antibiotic
Antipyretic
Analgesia
Bronchodilator inhaler
Oral steroids
GP
Nurses
Pharmacist
Paediatrician 12 hours
NoLimited
Comprehensive assessment and management models
 Walk-in centre for illness and injury in CYPAPNPs in walk-in centre using algorithms to manage a limited set of illnesses and common injuries. Paediatrician input available within 48 hours.Community centreTo 22:00 7 days0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

  4. Injury

Basic Ix
Basic XR
Basic lab IX 48 hours
Micro 48 hours
Reassurance
Health education
Oral rehydration
Oral antibiotic
Antipyretic
Analgesia
Bronchodilator inhaler
Oral steroids
Basic resuscitation
GP
Nurses
Pharmacist
Radiographer
Paediatrician 48 hours
Yes <6 hoursLimited
 PACS (primary and acute care system) acute health centre for CYPGPs, APNPs providing a walk-in service for CYP on hospital site with rapid access (<4 hours) to paediatric and other specialists, thus able to manage a very broad range of illnesses and injuriesGP practice on hospital siteTo 22:00 7 days0–17.9 years
  1. Transiently unwell child

  2. Exac of LTC

  3. Complex LTC/disability

  4. Injury

Basic Ix
Lab IX 12 hours
Micro 12 hours
XR and US 12 hours
All management excluding IV fluids or IV treatmentsGP
Nurses
Pharmacist
Radiographer
Paediatrician 4 hours
Other disciplines or specialists 4 hours
Yes <6 hoursYes
  • APNP, advanced paediatric nurse practitioner; CYP, children and young people; Exac, exacerbation; GP, general practitioner; IV, intravenous; Ix, investigations; LTC, long-term condition; NG, nasogastric; Obs, observation; Rx, treatment; US, ultrasound; XR, X-ray.

  • Hours, all data collection started from 10:00 however actual models start from 8:00 or 8:30.