What are “Learning Together” clinics?
These are child health clinics within GP practices that provide training. These clinics are jointly run by the GP registrar placed within the practice, and a senior General Paediatric trainee (ST6-8, or ST5 with competencies), visiting from the local secondary care provider (i.e. working in the same room seeing patients together). Trainees are paired according to location so that the Paediatric trainee is from the Trust that the GPs normally refer to. Each pair conducts a series of at least 4-6 joint clinics. The clinics are based around a series of patient appointments but will also include ‘virtual MDTs’ (discussion about the patient without them physically being in the clinic) and other educational activities.
The purpose of putting Paediatric Registrars and GP registrars together running a joint clinic is for joint and peer learning: each can learn from the knowledge, skills and attitudes of the other.
Children seen in these clinics are a mixture of “booked” patients – either secondary care-type referrals, or review of long term conditions – and “hot” or “emergency” children who are booked in that day. The Paediatric and GP trainees see the children together, taking turns in leading the consultation, but both contributing. At the end of the clinic, participants feed back to the Primary Care team, allowing continuity of care, and cascading of learning to the wider team. Paediatric trainees return to their place of work and discuss patients seen with their Paediatric supervisor often via email.
Follow up discussion across the teams happens in the same way, facilitated by the trainees. Supervision is provided jointly by GP trainers and Paediatric Consultants but clinical responsibility remains in Primary Care.
Learning from the Pilot programme
Learning Together delivers opportunities to work clinically in an integrated way, learning and working collaboratively. Feedback suggests that the training for GPs can be more meaningful and relevant than traditional “acute” hospital posts. For those GP trainees who do not do Child Health placements during their training, it offers the opportunity to develop child health knowledge and skills. It also develops collaborative working.
Paediatric trainees who are involved gain experience of working differently and have an opportunity to experience the Primary Care perspective. Evaluation and feedback from the pilot project has been overwhelmingly positive with some early suggestion that outcomes are improved. All involved report rich learning in many different domains.
Learning Together clinics were developed from pilot work in London, supported by HENCEL through UCLP, in North and West London, and HESL in South London. For evaluation and outcomes see the “Why” section. The clinics are now being rolled out in London, supported by the London School of Paediatrics and London GP training. Schemes are also being run in Oxford and are in development elsewhere. Please contact us to see if there are clinics taking place in your area.
Interest has also been expressed from other specialties due to the transferability of the educational framework of Learning Together – pilots are taking place in Elderly Care and Psychiatry.