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NHS 10 year plan: A community shift that works for children - briefing

Health Policy team
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We call on all RCPCH members in England to input into the new 10 Year Health Plan for the NHS, both via the Change NHS Portal and through any Trust or regional opportunities. This is your opportunity to make the case for children and the child health workforce to be at the centre of plans for the NHS, and we need a strong collective voice to ensure they are not forgotten.

This briefing outlines the value of providing child health services in the community, and the current pressures across children's community services and primary care. We want to see the shift into the community work well for children and families, but it will not do so without additional investment and focus. The briefing outlines our recommendations to recover children's community services, invest in community paediatrics, improve training and support for GPs and improve the interface between primary and paediatric secondary care.

We encourage members to use the evidence, key messages and recommendations provided here to support your own engagement on the 10 year plan.
Last modified
21 November 2024
Post date
21 November 2024
Table of contents
Contents

Proposed shift 

The proposed ‘hospital to community’ shift would enable more people to access healthcare closer to home. Organisations including RCPCH, the King's Fund and the NHS Confederation have previously called for a greater focus on and investment in community services in national health policy. The government has now acknowledged that the health system in England has been largely focused on acute services, with less attention given to the important role that community provision can play in helping people to stay well, and in providing high-quality care when they are sick or have chronic health needs.

The Government has announced that a key part of this shift be new ‘neighbourhood health centres’, which will co-locate doctors, care workers, physiotherapists, health visitors, mental health specialists and other health professionals in one place.  

This shift encompasses several different types of health provision: 

  • The role of community health services - For children, these services include community paediatrics, speech and language therapy, occupational therapy, CYP wheelchair and equipment services, and children’s community nursing, among others.
  • The role of primary care provision - This could include GP Practices, proposals around ‘neighbourhood health teams’, and Child Health Hubs.
  • Plans to move wider health provision closer to home through new models of care such as acute respiratory infection hubs, or within the home environment through virtual wards - This shift includes more community healthcare provision for children with medical complexity and disability.

Child health challenge

Key messages

We support the principle of providing healthcare in the community and recognise that children and families value high-quality services closer to home. However, for this shift to work well for children and be sustainable for the child health workforce, children’s community health services urgently require further investment and service transformation.

Community child health teams are already overstretched, with record-high waiting lists, limited resources and longer waits than almost any other part of the health system. Any increase in community provision must be underpinned by additional investment in children’s community services and a focus on the multidisciplinary community workforce and address the tens of thousands of children already waiting over a year to access community services. There must be renewed focus on how primary care services are working for children, and how the interface between primary care and paediatric teams can be strengthened.

Acute paediatric services also face considerable pressure, with paediatric intensive care units regularly over 90% occupancy1 . It is therefore important that, at least in the short term, funding to improve children’s community provision must supplement, not replace, funding for acute paediatric services.

Successful examples such as Child Health GP Hubs and paediatric Hospital at Home demonstrate that community care can work effectively for children and relieve pressure elsewhere in the health system, when the right support is in place. Investing in these models of care also offers a significant return on investment: for every £1 invested in community or primary care, there is a £14 return2 . 

Challenges in children's community health services

  • Children's community health services have some of the longest waiting times across the health system: 27% of children on the community paediatric waiting list have been waiting over a year, compared to just 1% of the adult community waiting list3 .  The number of children waiting over a year for community paediatric care has increased by 430% in two years4 . 
  • Over 272,000 children are on waiting lists for community health services, including community paediatrics, speech and language therapy, and occupational therapy.
  • The NHS Confederation and NHS Providers have warned of the ‘extraordinary’ pressure on children’s community services, and called for increased government investment and improved access to national funding for service recovery5 . 
  • Addressing workforce shortages is crucial:
    • The College has estimated that a 50% increase in community paediatricians is needed to meet current demand.
    • Other professions such as CYP speech and language therapists and occupational therapists also face significant recruitment and retention challenges.
    • The ageing workforce compounds this issue, with the average community paediatrician now 52, over half working less than full time, and many signalling their intention to retire in the next few years. 
  • Delays in accessing community health services have a significant lifelong impact. Many interventions need to be given by a particular developmental stage, and missing this can profoundly impact speech, mobility, learning and development. 

Moving more care into the community is not feasible unless these current service pressures are addressed.

Primary care challenges

  • Primary care is often the first point of contact to the health system for children and families. Effective support in primary care is crucial, but changes to primary care mean that some services struggle to meet children’s health needs.
  • A £1 billion reduction in the public health grant since 2015 has reduced access to health visiting, prevention and early support services, leaving many families without the help they need.
  • Less than half of GPs now receive postgraduate training or placements in children’s health. Many GPs only have a few weeks of undergraduate training on children’s health, but are expected to be the first line of assessment and treatment for children and young people.
  • GPs are under considerable pressure. Alongside improving training on child health, the primary care workforce needs adequate investment, support and the capacity to do this well.
  • Strengthening the interface between primary care and paediatric secondary care is equally important. Successful initiatives like Child Health GP Hubs, show how delivering joint clinics, education, and rapid access to paediatric advice can enable primary care services to support children more effectively.

RCPCH recommendations

Address the current long waits in children’s community health services

The Government must first address the current long waiting times in community child health services, as a core part of recovery efforts. 

This should be central to the new elective recovery plan, and dedicated support and guidance should be provided for ICBs and Trusts to reduce their long waits, and ensure no child is left waiting for over 18 weeks for healthcare.

Invest in the community child health workforce

This includes addressing the growing workforce gaps for community paediatricians, speech and language therapists, occupational therapists and physiotherapists. 

This will involve some additional investment, but also work to understand the barriers to working in the community.

Implement postgraduate training on children’s health as a core part of GP and wider practice staff training. 

NHS England's Workforce Training and Education (WT&E) Directorate should work with Royal College of General Practitioners (RCGP) and RCPCH to develop a training framework in children’s health competencies for all GPs, to ensure they have the knowledge, experience and confidence to manage common paediatric presentations.

Promote models of joint working between primary care and paediatric teams. 

Every Integrated Care System and Primary Care Network should be supported to develop models of joint working between primary care and paediatrics, using examples of best practice such as the Child Health GP Hub model. 

Ensure plans for neighbourhood health teams consider the needs of children and young people, and ensure that child health professionals are a core part of these teams

The development of ‘neighbourhood health teams’ must consider the needs of children and young people, and how they will include the children’s health workforce. 

It is crucial this not only considers young children and their families, but specifically considers the needs of adolescents and ensures there are appropriately trained staff working in these teams who can meet young people’s needs in the community.