Paediatric NHS 111 Clinical Assessment Services pilot: an observational study

Correspondence to Professor Ian Maconochie, Children and Young People's Transformation Team, NHS England and NHS Improvement London, London, UK; [email protected]

What is already known on this topic?

• Around the UK, commissioners have different models for delivering NHS 111, GP out-of-hours and urgent care services, focusing on telephony to help deliver urgent and emergency care.

• During the early phases of the COVID-19 pandemic, NHS 111 experienced an unprecedented volume of calls, many of which related to children and young people (CYP).

• In response, NHS England and NHS Improvement assisted in re-deploying volunteer paediatric clinicians into the Clinical Assessment Services (CAS), taking calls about CYP.

What this study adds?

• Calls about under 16-year-olds resulted in significantly higher self-care disposition rates when responded to by paediatric compared with non-paediatric clinicians, with likely cost savings.

• Paediatric clinicians enjoyed working for NHS 111 CAS and perceived that they added value.

• Parents/carers appeared to find speaking directly to a paediatric clinician in NHS 111 CAS satisfactory and helpful.

Introduction

In the financial year 2019–2020 (over 12 months), there were c. 300 million primary care consultations in England, up to two-fifths of which were accounted for by children and young people (CYP) aged under 16 years.^{1 2} Over the same time period, there were 25 million emergency department (ED) attendances, over 6 million of which were from under 16-year-olds.³ Children are more frequent users of ED than any other age group,⁴ and only about 11% of CYP who attend ED are admitted into hospital,^{4 5} which suggests that their medical needs could better be served through other services. If current trends are unchecked, there is a potential significant shortfall in ED capacity to deal with demand in future.⁶

Many ED CYP presentations are for relatively minor or self-limiting illnesses such as abdominal pain, constipation, asthma/wheeze, bronchiolitis, diarrhoea/vomiting, fever and head injury, and could be diverted to more appropriate settings (such as rapid-access clinics, hospital at home, ambulatory care units) or managed at home.⁴ This needs to be addressed to improve access to ED for children who need to be seen urgently; furthermore, these visits suggest that many worried parents are currently either unable or unsure how to use other means to access the reassurance or...