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Advanced Paediatric Nurse Practitioners (APNPs)

There is a national shortage of Paediatricians in post and in training. Across Cheshire and Merseyside paediatric services have, in recent years, struggled with significant workforce shortages. Reasons behind this issue can be linked to the national drive towards 24/7 working, the change to junior doctors contacts and a reduction in the number of trainee paediatricians. The workforce challenge is broader than just doctors and nurses and there are opportunities to think creatively about new roles to deliver health care across the system.

Working with our partners Kids Health Matters, we have created an online education platform that delivers specialist paediatric modules which results in an MSC Advanced Clinical Practice in paediatrics or neonates. This is delivered with Liverpool John Moores University. The current routes are:

  • Neonatal Advanced Practice
  • Ambulatory Advanced Paediatrics
  • Acute Care Advanced Paediatrics

The three training routes ensure that the Advanced Clinical Practitioners (ACP's)can provide clinical expertise in both acute and community settings. The training programme is the only stand alone bespoke Masters course in advanced paediatric and neonatal care and is currently being delivered in collaboration with Liverpool John Moore's University. The interactive online mode of delivery means that it is accessible to students from a wider catchment area.

The introduction of trained ACP's within the workforce is part of the solution to system issues and will enable care can be delivered in the right place, right time by the right person, putting clinical expertise into the community to support care closer to home and prevent dependence on hospital services. Our ACP clinical experts can act as as a conduit between GP's , hospital paediatric teams and Emergency departments, to help to alleviate some of the pressure on hospital services and give parents the confidence to use alternatives to A&E for non-emergency care.

Within a year we will have 18 new trainees on rota across Cheshire and Merseyside – with a new cohort of 35 in training. Health Education England has recognised the effectiveness of this new approach to service modelling and has provided funding for 20 of these places.

We have developed a Governance document to sit along side the course which gives guidance to organistions from planning to implementation of an ACP workforce – this document has been commended by HEE and has been accepted by Cheshire and Mersey organistions as guidance.

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Big 6 Acute Care Pathways

Analysis of data and evidence shows that the commonest children's urgent care attendances to GP, ED and paediatric assessment units are:

  • Bronchiolitis
  • Croup
  • Gastroenteritis
  • Fever
  • Abdominal pain
  • Head Injury

We have chosen to call these the BIG 6 – our aim is to reduce the attendance of these conditions at hospital by implementing standardised pathways and advise.

We are working with service users and our clinicians across primary, community and secondary care to develop these standardised pathways of care using best evidence and NICE guidance to inform and aligning to local community provision to help support the safe management of children with these conditions without needing a hospital attendance.

We are confident that if we can establish a pan Cheshire and Mersey approach to pathway development this can be can be the template for future working to aid system wide change and spread good practise with proven outcome benefits to children and families.