COVID19: QI From the Frontline 30th March, 2020

Paediatric Cluster Clinics

What is a cluster clinic?

A cluster is a group of approximately six neighbouring primary care centres. There are four clusters in Aberdeen City and six in Aberdeenshire. A cluster clinic is where all referrals from that cluster are cared for by a single senior decision-maker who is a paediatrician, usually a consultant.

How are cluster clinics different to “normal” paediatric clinics?

1. Fewer clinic appointments are needed. ​In “normal” clinics, one person checks all referrals from all clusters. This single person does not have time to sort out problems which can be quickly resolved. In the cluster clinic, the paediatrician has fewer cases to vet and can sort out many with a phone call.
2. Parents and carers get information more quickly. In “normal” clinics, the clinical team do not usually contact the family ahead of the appointment. Before the first face-to-face meeting in the cluster clinic we often write with self-management advice (e.g. constipation), or speak to a parent and start a trial of treatment (e.g. asthma treatment).
3. Cluster clinics take place in a primary care/community setting within the cluster boundary.
4. Children attending a cluster clinic are seen by either a GP with training in paediatrics or the paediatrician who does the vetting.

Why does this work?

Key to the success of the cluster clinics are:

• The cluster structure.
• The Trak IT system which allows the clinic to be delivered anywhere in NHS Grampion (including clinical contact notes).
• The outpatient administration team at Royal Aberdeen Children’s Hospital (RACH).
• Enthusiasm from the GPs, paediatricians and their management structure.
• Education in primary care (including Grampian Guidance documents).

What has been found out so far?

• The first cluster clinic started in April 2018, three more started in April 2019, and more will start in 2020 (see map below).
• Up to one third of referrals are resolved without a clinic appointment.
• Parents and children appreciate being seen more quickly and not having to visit RACH.
• Fewer tests are requested in cluster clinics and there is no evidence of increased referrals to general or specialty paediatric clinics since starting the cluster clinic.
• The number of patients waiting to be seen fell from 492 in May 2018 to 148 in August 2019, and 85-90% of children seen in clinic were discharged from follow up with no evidence of re-referrals.

Cluster Clinics have been a 2-year innovation in progress and our experience is now used in the current COVID-19 response.

Enquiries to Prof Steve Turner, Consultant Paediatrician at Royal Aberdeen Children’s Hospital

s.w.turner@abdn.ac.uk or 01224 554587

Map showing the site of present and future cluster clinics in NHS Grampion below: