Families, Young People and Children s Services (FYPC) Community Paediatric Service Referral Guide This guidance is to assist those in frontline services to know who, what and how to refer to the Community Paediatric Service, and to improve access to community paediatricians for those children and young people who need it most. Key Words: Referral Version: Version 7-11 November 2013 Adopted by: Date adopted: Name of originator/author: Name of responsible committee: Date issued for publication: Review date: November 2014 Expiry date: Target audience: Michael Sheldon, Interim Service Manager CAMHS and Community Paediatrics Type of Policy Clinical (tick appropriate box) NHSLA Risk Management Standards if applicable: State 00Relevant CQC Standards: Non Clinical 1
CONTRIBUTION LIST Key individuals involved in developing the document Name Dr K Patel Mr M Sheldon Designation Lead Consultant Paediatrician Service Manager Circulated to the following individuals for comments Name Designation 2
Contents Equality statement...... 5 1.0 Introduction... 5 2.0 Purpose... 5 3.0 Age Range... 5 4.0 Clinical Indications for Referral.... 5 5.0 Conditions not covered by the Community Paediatric Service... 6 6.0 Statutory Roles.... 6 7.0 How to refer... 6 8.0 Who can refer.. 7 9.0 Deciding whether to refer to Community Paediatrics 7 10.0 Geographic Coverage/Boundaries.. 7 11.0 Consent 7 Appendices: Appendix 1 Appendix 2 Appendix 3 Alternative Services for those not meeting our referral criteria Care Pathway for Overweight and Obese Children Referral Pathway Children with Constipation 3
Version Control and Summary of Changes Version number Version 7 Date Comments (description change and amendments) 11 November 2013 Correct format All LPT Policies can be provided in large print or Braille formats, if requested, and an interpreting service is available to individuals of different nationalities who require them. Did you print this document yourself? Please be advised that the Trust discourages the retention of hard copies of policies and can only guarantee that the policy on the Trust website is the most up-to-date version. For further information contact: Michael Sheldon, Interim Service Manager CAMHS and Community Paediatrics Families, Young People and Children s Services Leicestershire Partnership NHS Trust Bridge Park Plaza Bridge Park Road Thurmaston Leicester, LE4 8PQ 4
Equality Statement Leicestershire Partnership NHS Trust (LPT) aims to design and implement policy documents that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. It takes into account the provisions of the Equality Act 2010 and advances equal opportunities for all. This document has been assessed to ensure that no one receives less favourable treatment on the protected characteristics of their age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex (gender) or sexual orientation. In carrying out its functions, LPT must have due regard to the different needs of different protected equality groups in their area. This applies to all the activities for which LPT is responsible, including policy development, review and implementation. 1.0 Introduction The Community Paediatric Service provides assessment, diagnosis, management and where indicated, treatment to children and young people across Leicester, Leicestershire and Rutland. The service is delivered in a locality secondary care setting by specialist doctors in partnership with other providers, enabling children and young people to achieve their optimum health and reduce the impact of illness on their health and wellbeing. The service also carries statutory duties in relation to child protection, medical advice for special educational needs, and health assessments of children in care. Referrals should wherever possible come with an accompanied social history. 2.0 Purpose This guidance is to assist those in frontline services to know who, what and how to refer to the Community Paediatric Service. It is also designed to improve access to community paediatricians for those children and young people who need it most. 3.0 Age Range New referrals will be accepted for children and young people up until 16 years of age. If a young person is at a special school, referrals can be accepted up to the age of 19 years. 4.0 Clinical Indications for Referral Concerns regarding a child s development such as developmental delay or disordered development Neurological disability e.g. cerebral palsy or other physical disabilities Children with coordination difficulties 5
Behavioural problems in association with disordered development or when there is a suspected underlying neurodevelopmental disorder e.g. o Autistic Spectrum Disorder primary school age see ASD pathway link http://intranet:8006/default.aspx o ADHD (unless mental health disorder or oppositional behaviour in a secondary school age child) Genetic Disorders needing paediatric medical follow up e.g. Down s Syndrome Significant learning difficulties / disabilities (NB children with isolated mild learning difficulties will not be assessed) Constipation or Enuresis with one or more of above co-morbidities Symptom management in children with life-limiting conditions General medical paediatric conditions after referral by GP. 5.0 Conditions Not Covered by the Community Paediatric Service Assessment for Dyslexia (or other specific learning difficulties) Assessment of significant emotional and behavioural difficulties in school age children unless as part of a formal assessment of Special Educational Needs. (Appendix 1 may be of use) Isolated speech and language difficulties e.g. stutter Obesity Attached is a list of services (Appendix 1) which is to provide guidance for those referrals that do not meet our criteria. 6.0 Statutory Roles Medical Advice for Special Educational Needs is accessed through Education. Child Protection Referrals are made through Children s Social Care Services. Advice can be sought via the Safeguarding Office, Bridge Park Plaza, Telephone 0116 295 2524. Looked After Children Medical Assessments are coordinated by the Looked After Children s Service, Bridge Park Plaza, Telephone 0116 295 2522. 7.0 How To Refer By the Families, Young People & Children s Services Referral Form. Referrals are still accepted by letter but in the future it is proposed that only those referrals made on the Child Health Service Referral Form will be accepted to ensure all relevant details are captured. Incomplete referral forms will not be accepted and returned to the referrer for more information. 6
8.0 Who Can Refer FYPC Health Visitors, School Nurses and Allied Health Professionals Hospital Paediatricians GP s Social Care Services only for statutory work Education Educational Psychologists, Special Educational Needs Coordinators (SENCo s) CAMHS 9.0 Deciding Whether To Refer To Community Paediatrics Appendix 1: Alternative services for those not meeting our referral criteria Community Paediatricians will accept referrals for those with emotional or behavioural issues that also have physical symptoms that require a paediatric assessment or where a neurodevelopmental condition i.e. ADHD / ASD is suspected. See Appendix 1. 10.0 Geographic Coverage/Boundaries The service will be provided to children and young people registered with any GP within Leicester, Leicestershire and Rutland who contracted to the coordinating commissioner or one of the associate commissioners. 11.0 Consent It is always expected that consent has been obtained from someone with legal parental responsibility or by the young person themselves if they are felt to have the capacity to consent prior to a referral being made. 7
References and Associated Documentation To include a list of all references, including references to other Trust s policies, etc. This policy was drafted with reference to the following: NICE Guidelines, see Appendices 1, 2 and 3 8
Appendix 1: Alternative services for those not meeting our referral criteria Problem: General General medical conditions (e.g. asthma, eczema) Obesity NICE Guidelines. See Care Pathway (Appendix 2) Immunisations specialist advice Hearing Concerns Constipation with no co-morbidities (Appendix 3) -NICE Guidelines Enuresis with no co-morbidities (aged >7) (Appendix 3) Migraine & Chronic Fatigue Headaches Squint Developmental / behavioural Behavioural and emotional problems. Child under 5. Behavioural and emotional problems. Child over 5. Severe mental health concerns i.e. anorexia / deliberate self harm Gross motor coordination problems without other developmental disorder / neurology Gait or lower limb posture without other developmental disorder / neurology Speech / language problems without other developmental disorder / neurology Learning school aged child Specific learning difficulties (e.g. dyslexia) General learning difficulties / school underachievement (except to identify underlying medical/genetic conditions) Severe learning disability with emotional / behavioural problems Parental request for statement of Special Educational Needs Parental request for a named school GP in first instance Consider referral to: Community Dieticians Weight Management Programme Endocrinologist if signs and symptoms of co-morbidity Public Health Paediatric Audiology service School Nurse/GP School nurses Family Health Visitor to work with parents to establish healthy toileting behaviour GP GP in first instance Combined Care Clinic Opthamology-UHL HV / family support workers (e.g. from children s centres & nurseries). Fun and families School nurse / family support workers (e.g. from children s centres) CBII/Family Steps. Fun and Families CAMHS Paediatric Physiotherapy and Occupational Therapy service Paediatric Physiotherapy service may accept referrals, subject to normal development guidance. Direct referral to an orthopaedic specialist or orthotics may be more appropriate in some cases. Paediatric Speech & Language Therapy service. Consider referral to paediatric audiology to test hearing. Consider vision and hearing referrals. Educational assessment (Educational Psychology / literacy support service) at discretion of school. Special Educational Needs Coordinators. Independent services (funded by family). Consider vision and hearing referrals. Educational assessment (Educational Psychology / learning support service) at discretion of school SENCo. Specialist CAMHS LD service (Generic CAMHS referral form) Nurse / Psychology / Psychiatry Consider vision, hearing and dental referrals. If discussion with school fails or further advice needed, parents to contact Parent Partnership Scheme City Tel 0116 2575027 County Tel 0116 2752097 Health professionals should not make specific recommendations about a school placement. The decision about school placements is the responsibility of the Education Authority 9
Appendix 2 10
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Appendix 3 12
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