Due to the increasing demands and pressures on GP practices, the clinicians in the General Practice Support Team (GPST) have come up with some simple and effective ideas to support GP practice teams to manage / reduce some of the pressures from parents asking for appointments for their children. The idea is to direct parents/guardians to a variety of self help leaflets and videos.  The intention of this project is not to block access to appointments for sick children but to inform parents/guardians about simple self management measures they can employ to look after their children without taking up GP appointments desperately needed for those sicker children who do need to be seen.

We all get nervous about missing a truly sick child and thus it is important to listen to parents/guardians and their real concern. Whilst we will not turn children away, there are a few simple steps that can be taken, especially when we hear those words ‘the school/nursery has told me to bring my child for a check up after bumping their head (etc)’.

It is important to be clear on the markers of a really sick child. Please consider watching the following video about this.

Resources

We are endorsing the excellent leaflet ‘When should I worry?’ (produced by Cardiff University - 2016 revised version), and want to promote this by using videos, QR code posters with links to the leaflet and additional NHS videos. Click the images below to access the leaflets.

Other translations are available at http://www.whenshouldiworry.com/

If you are planning on using the leaflet in consultations, we recommend that you complete the free training in use of the booklet on the project website first, and that you thoroughly familiarise yourself with the booklet contents.

There is also a leaflet for parents/guardians regarding ‘what to expect after immunisation’ which can be downloaded here:

What To Expect After Vaccinations Leaftet Link

The GPST are producing posters with QR codes that can take patients to the leaflets and a selection of videos. These posters will be delivered to Cardiff & Vale Practices for use in your waiting rooms within the next few weeks.

Below are a list of 10 potential actions your surgery may chose to take to promote this form of self care.

Top Tips

Here is our list of tips to utilise these resources:

1. We would advise that this is a whole team project so that everyone is promoting the same messages to include receptionists, nurses, HCSWs, pharmacists, administrators, health visitors and GPs. Receptionists are the first port of call so they are in an ideal position to signpost parents/guardians to the relevant information. They could raise awareness of the website and or leaflets for parents booking appointments for sick children. Receptionists can also direct patients to the local chemist under the ‘choose pharmacy scheme’ – be aware that some age restrictions apply to some conditions.

2. You could update your telephone answer message – consider adding a suggestion that parents/guardians seeking appointments for sick children take a look at the video/leaflet on the practice website to see if they can manage the illness first. Keep in mind the length of these messages as patients are becoming increasingly frustrated at the increasing length these communications.

3. Put the ‘When should I worry?’ leaflet on your practice website (English and Welsh version available).  Put links to the leaflet on practice Facebook page and Twitter before Christmas/New Year. Upload the leaflet on to your clinical system and create a protocol that enables it to be printed when a certain Read Code is used by a clinician or can be launched by your reception team when required. 

4. Embed these videos on your practice website; 

‘Caring for children with fever at home’ NHS choices by Dr Ranj Singh https://www.youtube.com/watch?v=kgHhtPDIw0A

Chicken Pox https://www.youtube.com/watch?v=AVqYC7hHNUU

Cough https://www.youtube.com/watch?v=4Wt_scT9Kwk

Diarrhoea and vomiting https://www.youtube.com/watch?v=HrhajHaWvFs

Dental Problems https://www.youtube.com/watch?v=sXYOrm8_iuo

Earache https://www.youtube.com/watch?v=luxVQ6XinxM

Constipation https://www.youtube.com/watch?v=hPIX03DRCq0

High Temperature https://www.youtube.com/watch?v=-vfpAAsUQTc

Minor Head Injury https://www.youtube.com/watch?v=xFtywVvjWoI

Rash https://www.youtube.com/watch?v=IghuRDJ-9Vo

Runny Nose https://www.youtube.com/watch?v=ajBtrLDvyEI

Guide to A&E https://www.youtube.com/watch?v=iyrJUmfXyTQ&feature=youtu.be

Antibiotics http://www.wales.nhs.uk/sitesplus/888/page/94022

Alternatively, if your website cannot embed videos, you could circulate this link which hosts the majority of them: http://www.cardiffandvaleuhb.wales.nhs.uk/childrens-health   

5. Leave ‘When should I worry?’ leaflets in the waiting room. The GPST have a small supply of these leaflets and will be able to get more if in demand. If you would like any hard copies of the leaflet please contact cav.gp@wales.nhs.uk (C&V practices only).

6. Have a discussion within your practice nurse team to encourage use of the leaflet ‘what to expect after immunisation’
 Make sure you have a supply of these leaflets – ordered from Health Information Resources at Public Health Wales. Link-in with the health visitor so the same message gets accross. Avoid the message to ‘contact OOHs with any problems’

7. You could send a MyHealth text with links to the video/leaflet to parents/guardians of all children under 12 years of age? Discuss within your Cluster if there is an underuse of texts and contact NWIS to redistribute

8. Display QR code posters in reception / waiting rooms and remind receptionists to signpost parents/guardians to them.

9. When GPs see parents/guardians with young children, take the opportunity to text a link to the leaflet/hand out a leaflet.

10. Many Telephone triage consultations are parents/guardians seeking reassurance over their ongoing care of their child. Following a history to check for serious problems, reassurance and advice, a text of one or more of the above leaflets/videos can cement that advice. A safety net of “Call back if the advice does not make sense or is not helping”, may avoid a face to face consultation and better empower the parent/guardians for future illnesses.

By following a few simple steps and working as a team there is potential to reduce the numbers of requested appointments, manage some children with mild problems at home, and to empower parents to manage their sick child now and in the future.

If you have any further ideas or feedback, please let us know via our email address cav.gp@wales.nhs.uk