Kathy Oxtoby speaks to Dr Sheila Shribman, national clinical director for children, young people and maternity services, about her views on GP commissioning
Why should children and young people be a priority for GP commissioners?
This is the most important area of the health service. Children and young people make up a significant percentage of the population – between 20% and 24%. It’s a vital time in life because what happens in pregnancy, early years and adolescence often determines future health.
Avoidable hospitalisations of children should be a priority for practice-based commissioners. In the last 10 years, data shows a rise in emergency admissions, predominantly in the under-fives and late teens. But children should not be admitted to hospital unless it’s absolutely necessary.
What has PBC done well in terms of children and young people’s services?
Until recently, PBC has not been particularly focused on children and young people. Notable areas of good practice are in Surrey, Sussex and the North West where commissioners have been improving services for acutely sick children.
And what could it do better?
More work could be done to help acutely sick children and also those with long-term conditions – for example, by improving the management of asthma.
What’s held PBC back in the area of children and young people and what will change this?
The initial focus of PBC was on areas where a lot of costs were being incurred, particularly long-term conditions in adults. As PBC has developed, commissioners have realised the value of looking at children and young people’s services.
PBC should focus more on services for sick children and child health, to improve quality of care and reduce costs. Recently, I’ve held meetings to look at care pathways for children and young people and we’ve also done some work on how to improve self-care, and target the neediest children in primary care services.
What’s impressed you about PBC?
I’ve met some extremely enthusiastic people who are involved with PBC. While this is encouraging, it’s early days for it to have a significant impact on children and young people because it’s taken a little while for this area to get higher up on the healthcare agenda.
What are the three single things commissioners could do that would most improve health outcomes for children and young people?
Commissioners need to think about ways to reduce hospitalisation. They also need to find ways to better manage long-term conditions, developing care plans that are understood by the whole family.
I’m also a great believer in having strong children’s community nursing services. Parents say that having a children’s community nurse link for those with long-term problems is crucial both for their support and for liaison with primary and secondary care.
Is there anything that worries you about primary care clinicians involved in commissioning?
While some commissioners are developing a more sophisticated approach to developing children and young people’s services, others don’t yet have the expertise and experience. It’s an undeveloped area, so there’s clearly a need to enhance GP commissioning.
In your ideal world, how would GPs commission children’s and young people’s services?
It is essential to understand the local health picture for children and young people, to be aware of local services, to obtain accurate data and information and to look at what’s happening in general practice, A&E and hospital paediatric departments.
Is there any new guidance in the area of children and young people’s health that GP commissioners should look out for?
NICE is increasing its production of guidelines for a variety of childhood presentations – for example it has recently published useful guidance on constipation in children.
The Department of Health is producing a best practice guide to the management of childhood asthma in the autumn. DH experts have also sponsored Spotting the Sick Child – an internet training aid to help healthcare staff keep up to date in the assessment of sick children (www.spottingthesickchild.com).
Kathy Oxtoby is a freelance journalist
Dr Sheila Shribman, national clinical director for children, young people and maternity services Dr Sheila Shribman, national clinical director for children, young people and maternity services