Study finds ‘tremendous potential’ in GP–paediatrician care

A new model of collaborative care is combining the expertise of GPs and paediatricians, aiming to support GPs to practise at the top of their scope.
 
New research from the Murdoch Children’s Research Institute (MCRI) published in the Medical Journal of Australia has revealed the model not only gives GPs more confidence in paediatric care but also takes pressure off public hospitals.
 
Aiming to assess the effectiveness of the Strengthening Care for Children (SC4C) project for reducing the number of GP referrals for patients under 18 years of age to hospital services, the two-year study involved 22 general practices in North Western Melbourne and Central and Eastern Sydney Primary Health Networks (PHNs), with 130 participating GPs conducting more than 50,000 consultations.
 
It follows previously published data from the baseline period of the trial, before the integrated GP–paediatrician model started, with the new paper showing the trial led to a reduction in referrals to hospitals and private paediatricians, and an increase in GP confidence and knowledge of children’s health care.
 
Under the main study, paediatricians joined GPs for some consultations during in-person and telehealth visits with families to facilitate upskilling for GPs in the diagnosis and management of child health conditions. Paediatricians also undertook monthly case discussions with GPs and provided them with additional support.
 
Lead author, paediatrician Professor Harriet Hiscock, said participating GPs reported an improved scope of practice and confidence in managing child health problems.
 
‘They welcomed the ability to be able to do something and not just refer children to long waiting lists,’ she told newsGP.
 
‘Our model is proof that we can support interested GPs to work to top of scope.’
 
To implement paediatricians supporting GPs in primary care as part of a multidisciplinary team model, Professor Hiscock says funding and support for general practices to embed ‘this new way of working’ is key.
 
‘This could be via a shared Federal Government funding partnership with state governments supporting salaried paediatricians to do this outreach work, and the Government commissioning PHNs to support the change management processes that are needed to make these models work in a multidisciplinary team care model,’ she said.
 
RACGP Specific Interests Child and Young Person’s Health Chair, Tasmanian GP Dr Tim Jones, told newsGP the study has ‘tremendous potential’ to improve collaborative care and support for GPs to deliver care within the community without needing to refer out.
 
‘For a lot of what’s happening at the grassroots level in these programs, it’s reminding GPs of their core skills and how valuable they are,’ he said.
 
‘When we support GPs in doing that work [child health care], most of the time those referrals to paediatricians don’t end up being needed because the developmental concern goes away.
 
‘But we [also know] that GPs may not have confidence to do that, given all the complexity and uncertainty, so hence having a paediatrician in the room … really helps GPs feel more empowered that what they do is valued by the whole system and by families.’
 
Families who took part in the study also reported the model strengthened their preference for GP-led care for their children. Additionally, the study demonstrates strengthening primary care for children reduces the frequency of hospital referrals.
 
‘There will always be complex paediatric services, but many of the referrals that go into that system may actually be able to be managed upstream with the right supports,’ Dr Jones said.
 
‘This study shows if you do consult with people and build their confidence and capacity, it’s not just that referrals to those services temporarily go down, it’s that they stay down.
 
‘And that supports a good network of communities of practice with GPs, paediatricians, the allied health workforce, so a lot of that confidence keeps building in the background.’
 
The results show the model was most useful and sustainable for GPs who refer the most, by reducing referrals, especially in lower socioeconomic areas where access to paediatricians can be limited.
 
The authors say families could be better supported if the model is expanded to these areas, with a rural version of SC4C also being trialled across Victoria and NSW as these areas are ‘in great need’ of paediatric support.
 
‘The model should be scaled to parts of Australia where there are lots of families who cannot afford access to private paediatricians – ideally the growth corridors,’ Professor Hiscock said.
 
Both Dr Jones and Professor Hiscock sit on the Government’s Thriving Kids MBS Implementation Group, which met for the first time on Tuesday, with Dr Jones saying he wants to see national funding for models such as these considered as part of the initiative.
 
‘One of the things all these pilots have in common is that they’ve been funded out of the PHNs, and one of the really effective levers we could see government pulling to build capacity across our system are more of these initiatives in areas of need, because there’s willing GPs, there’s willing paediatricians,’ he said.
 
‘What we don’t have is funding that supports them working together, and PHNs are the obvious solution that breaches that divide.
 
‘For Thriving Kids, we have finalised what the models of care could be, but we’re now moving towards what the Medicare funding side could look like, and we’re meeting for the first time with government about teasing that out.’
 
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children’s health GP referrals multidisciplinary team care paediatric care primary health networks scope of practice