Paediatric Gastro-Allergy Symposium The speaker had sole editorial control over the content in this slide deck. Any views, opinions or recommendations expressed in the slides are solely those of the speaker and do not necessarily represent those of Nutricia.
The new synbiotic - primary and secondary care collaboration in allergy management Paul Netts - GP, Newcastle upon Tyne
The new synbiotic - primary, secondary and tertiary care collaboration (along with research departments) in allergy management Paul Netts - GP, Newcastle upon Tyne
Once upon a time...
Allergy Mx isn t just anti-histamines! Non IgE allergy!! The allergic march!!!
Were we alone?...
Survey of 57 GPs Time Out session May 2015 Questionnaire testing knowledge of presentation and management of cow s milk allergy
How often do you see children with cow s milk allergy? 45 40 35 30 25 20 15 10 5 0 weekly monthly yearly rarely no answer
How would you treat a child with persistent gastro-oesophageal reflux symptoms? 35 30 25 20 15 10 5 0
Would you consider changing the child s diet or formula if no resolution? 50 45 40 35 30 25 20 15 10 5 0 No No answer Yes
If yes, what diet or formula? 25 20 15 10 5 0
How would you treat persistent eczema? 30 25 20 15 10 5 0
Were we alone? NO things not great here..what was secondary/tertiary care like?...
Overwhelmed! Referrals increasing-?quality Food challenges increasing Under resourced
What to do and how to do it? LM & GV were well ahead of the game Vision for how allergy care should look across the region.
Education & Research Primary care Hubs GNCH tertiary care
Complex GNCH tertiary care Triage both new & follow up patients to Multisystem
Community based Hubs Easier access GNCH tertiary care Less complex cases Free up GNCH time
Newcastle Hubs Gateshead GNCH tertiary care Sunderland And beyond
Secondary care Hubs Primary care GNCH tertiary care Dietitian Allergy nurse
imap Primary care Hubs Improved recognition of allergic disease GNCH tertiary care Dietetic support
e-module Education & Research Primary care Primary to primary Hubs GNCH tertiary care Tertiary to primary Research- EVERYONE!
How do we get out? We want to work in a hub!
The e-module what is it? 12 week distance learning multimedia package 3 assessments Topics covered : IgE, Non IgE immunology, anaphylaxis, asthma, drug allergy, eczema
Can we have our hub clinic now? NUTH NGPS
What is a GP federation? Group of local GP practices that have formed a company together This is a PROVIDER company. Membership voluntary NGPS- approx. 50% Newcastle practices
Why did they have to be involved? Ensure other practices had a chance to be involved Previous joint working with NUTH- effective ways of working already in place NUTH can t enter into a contract with a single GP practice to provide services
Would they be interested? Their aims suggested so strengthen clinical governance and improve quality & safety of services to develop training & education strengthen capacity of practices to develop & tender for new services out of hospital to make efficiency savings/economies of scale eg back office functions to improve local service integration across practices & other providers.
Would NUTH be interested? Better Together agenda National strategy Need to find new models of care to meet ever increasing demand Starter for 10
Setting up a hub clinic Patient triage IT Legal Admin Clinical supervision & governance Staff Rooms and
Money
CCG funds
CCG funds GNCH for allergy services
CCG funds COMMUNITY ALLERGY CLINIC GNCH for allergy services
CCG funds COMMUNITY ALLERGY CLINIC Calculate set up/running costs NGPS GNCH for allergy services
CCG funds GNCH for allergy services COMMUNITY ALLERGY CLINIC Calculate set up/running costs NGPS Agree % tariff NGPS/GNCH
CCG funds GNCH for allergy services NGPS buys staff/it/rooms COMMUNITY ALLERGY CLINIC Agree % tariff GNCH/NGPS Calculate set up/running costs NGPS
CCG funds Staff /IT from GNCH allergy services NGPS buys staff/it/rooms COMMUNITY ALLERGY CLINIC- go! Agree % tariff GNCH/NGPS GNCH for allergy services Calculate set up/running costs NGPS
We did it! First clinic - 2 nd May 2017 Benfield Park First hub
Community clinic- now Allergy consultant Allergy nurse 2 GPs Dietitian & phlebotomist to come If it works
Community clinic- future Allergy consultant input to move to next hub in time. Supervision changes Nurse consultant /Secondary care. GP recruitment to other hubs? through NGPS as contract already in place Dietitian & allergy nurse essential In time GPs in these clinics can get involved in educating primary care
Auditing the clinic Numbers Patients seen DNAs GNCH new/fu ratio Significant events Impact on attendances eg A+E, dermatology Patient feedback GPs progress in achieving RCPCH competencies
Where are we now? HUB First one started & being assessed. PRIMARY CARE Where are we at?... Education & Research Primary care Hubs GNCH tertiary care
Survey of 39 GPs Time Out session May 2017 Questionnaire testing knowledge of presentation and management of cow s milk allergy
How often do you see children with cow s milk allergy? 45 40 35 30 25 20 15 10 5 0 weekly monthly yearly rarely no answer
How would you treat a child with persistent gastro-oesophageal reflux symptoms? 2015 35 30 25 20 15 10 5 0
How would you treat a child with persistent gastro-oesophageal reflux symptoms? 35 30 25 20 15 10 5 0 antacids ranitdine thickener ppi anti-histamines change of milk
Would you consider changing the child s diet or formula if no resolution? 2015 50 45 40 35 30 25 20 15 10 5 0 No No answer Yes
Would you consider changing the child s diet or formula if no resolution? 25 20 15 10 5 0 no no answer yes
If yes, what diet or formula? 2015 25 20 15 10 5 0
If yes, what diet or formula? 14 12 10 8 6 4 2 0 ehf nutramigen no answer soya lactose free use NoT guideline
How would you treat persistent eczema? 2015 30 25 20 15 10 5 0
How would you treat persistent eczema? 16 14 12 10 8 6 4 2 0 change of milk emollients steroids referral dermatology avoid dairy wraps
Confidence 2 more questions this time : In the past year do you feel more confident in diagnosing food allergy in children? In the past year do you feel more confident in managing food allergy in children? 18 16 14 12 10 8 6 4 2 0 yes no no answer
Reasons given for greater confidence Education sessions Care pathway Time out sessions Talk by Dr Michaelis MAP guidelines Guidelines RCPCH guidelines
Can we read anything into these results at all? No seismic change but. Building interest-high turn out at recent timeout session A sense of increasing knowledge eg seeing CMA monthly rather than annually Feedback from GNCH quality of referrals and Mx pre clinic improving
Still some work to do
Where are we now? HUB PRIMARY CARE EDUCATION & RESEARCH What is needed to support & develop primary care? What is already happening? Education & Research Primary care Hubs GNCH tertiary care
Research ASSIGN study- Synbiotic in Non IgE mediated cow s milk allergy NIHR Principle Investigator Award 2016 Collaborative workingprimary/tertiary care.
Education to support primary care- ongoing @NPAGnetwork
Education to support primary care- upcoming education events GP evening food allergy guidelines- Mon 26 th June 2017 Allergic Rhinits symposium- 3 rd July Food Allergy Day Mon 18 th Sept 2017 Immune tolerance day- 18 th Oct 2017 Annual Education &Research Day- Feb 2018
How to support primary care- future Advice and Guidance service Further education Podcast/ webinars Series of evening meetings? primary care to primary care
What have Sian and I learnt so far? A lot of the focus is about ways to introduce/ re introduce food rather than just about avoidance Collaboration really is rewarding Specialist nurses & dietitiansworth their weight in gold Good care can be cost effective
What have Sian and I learnt so far? Living with an IgE food allergy really is tough going Keep following people up-avoid the 5 yr old still on ehf. One lecture on immunology at medical school wasn t enough The peanut is a legume, the coconut a vegetable who knew!!
Unite in paediatric allergy education and research Northern Paediatric Allergy Group @NPAGNetwork Twitter stream #NCLgastroallsym Allergy emodule - enquiries: pgclinhealth@ncl.ac.uk
THANK YOU paul.netts@nhs.net