Community Paediatrics | Barnsley Hospital Placement information for resident doctors, GPVTS and Foundation Year Doctors
1
This induction booklet will hopefully give you a rough guide to what you will cover in induction and also provide some useful tips to support your placement. Contents Induction meeting discussion points…………………………………………………………………………………………
3
IPC balance wheel………………………………………………………………………………………………………….…………
4
Post Introduction, Learning Outcomes and Competencies………………………………..……………………
6
Training Expectations………………………………………………………………………………………………………….……
12
Learning opportunities and how to access………………………………………………………………………….……
14
Community Paediatric Teams – who we are………………………………………………………………………………
18
Locality information……………………………………………………………………………………………………….…………
20
Community teaching and meetings………………………………………………………………………………..…………
21
Alternative resources for understanding Neurodiversity……………….…………………………………………
22
Clinical Letters – advice and guidance for trainees …..……………………………………………………..………
23
Dictation advice….…………………………………………………………………………………………………………………….
27
Onward referral advice………………………………………………………………………………………………….…………
30
Requesting investigations…………………………………………………………………………………………………………
32
Useful acronyms…………………………………………………………………………………………………………….…………
33
Suggested community clinic templates……………………………………………………………………………………..
34
The Email Charter………………………………………………………………………………………………………….…………
41
Wellbeing and burnout.……………………………………………………………………………………………….…………..
43
Kindness in healthcare.……………………………………………………………………………………………….……………
44
Trainee guidance for independent clinics in community paediatrics………………………….……………
46
Your notes………………………………………………………………………………………………………………………………..
48
Department: Community Paediatrics New Street Health Centre BARNSLEY, S70 1LP
T: 01226 644876 E: Barnsley.CommunityPaediatrics1@nhs.net E: Barnsley.ASDAT@nhs.net
Co-Production Team Author: Dr Claire Enevoldson, Consultant Community Paediatrician Design: Matt Smith, Specialist Autism Practitioner Editor: Ruth Mappin, ASDAT Coordinator Version 1.2 (Published 10th February 2025 | Last updated: 12/08/2026)
2
Induction meeting discussion points Core Learning Opportunities 1. Neurodisability a. Consultant clinics b. Greenacre c. History taking d. Early developmental impairment article 2. Autism a. ASDAT process b. ASD Post Diagnosis Leaflet - Signposting to support 3. Looked after Clinics a. IHAs b. Adoption Medicals c. Adoption Panel d. Example of IHA
Additional Learning Opportunities and Multiagency Working 1. Therapy 2. CAMHS 3. Education 4. Integrated Care Board 5. Safeguarding, Social Care and Child Death 6. 0-19 Team 7. Palliative Care, Specialties and Complex Neurodisability
3
ICP Balance Wheel – At start of placement
ASD) ( sm i t Au
Home &
Ho bb ies
Neo n a t es
hildren C r fte A ed k oo
Neuro disa bili ty
diatrics Pae ral ne Ge
L S
4
up ing pp te
to SpR
Sa f e g u ar d i n g
ICP Balance Wheel – At the end of placement
ASD) ( tism u A
Home &
Ho bb ie
s
ed k oo
Neo n a t es
ildren h C r e Aft
Neuro disa bili ty
diatrics Pae ral ne Ge
L S
5
up ing pp te
to SpR
Safegu a r d ing
Post Introduction, Learning Outcomes and Competencies Welcome! We look forward to working with you as part of the team here in Barnsley, and hope that you’ll enjoy your time in community paediatrics. Community Paediatrics is based at the New Street Health Centre, Barnsley (S70 1LP) with satellite clinics across Barnsley and at Greenacre special school. The team, including doctors, nurses, SLT and administrative staff are all based upstairs in New Street.
When you start: •
Please leave the secretaries your mobile number in case they need to contact you in an emergency.
•
Ensure your rota reflected on your NHS calendar (outlook) and this is shared with Shirley Higginbottom.
•
See Matt Smith Specialist ASD Practitioner and Team Leader to get an office access fob.
•
You will need access to \\storage01\schoolhealth and to SystemOne for initial health assessment reports and other community resources, any problems ask IT helpdesk on 01226 432771 or it.bdg-tr.itservicedesk@nhs.net
Logistics: • • •
Traveling to New Street by car, please use postcode S70 1LP or w3w///late.filled.logic Barnsley Transport Exchange is situated in the heart of the town centre, less than a ten minute walk from New Street Health Centre. Parking is available around the centre and is situated within a 1 minute walk eg: Onsite
Morrisons NCP
Cost: Free all day (Spaces are very limited and often fill up early) Directions: S70 1LQ | w3w///novel.poker.racks | Entrance via Morrisons Cost: Free under 2 hrs, £3 for full day - Cashless, payable via RingGo app only. Directions: S70 1LQ | w3w///novel.poker.racks | Rear of the health centre Cost: £2 for full day | Cashless | payable via NCP app only Directions: S70 1LW | w3w///lakes.plates.fines | Directly across from the health centre
•
On-calls take place at Barnsley Hospital, you should make your way to the children’s ward for evening handover at 16:30 on the days you are on-call (on Tuesdays handover follows 4pm teaching currently running virtually).
•
Tea and coffee and biscuits money is to be paid to the nurse’s office but feel free to bring your own.
6
Learning outcomes and competencies There will be 3 main threads running through your placement here. These are clinics you will be booked into observe and once you have had your midpoint meeting and feel competent, then you will be observed in undertaking some clinics under direct supervision yourself. These clinics run daily (usually the morning) and you will do these throughout your placement here. 1. Neurodisability 2. Autism Assessments 3. Looked after children Neurodisability clinics Learning outcomes •
Demonstrate proficiency in taking a focused development history in a child presenting for the first time with early developmental delay
•
Demonstrate proficiency in requesting appropriate first line investigations
•
Contribute with other professionals to the management of children with lifelong disability
How we will achieve this •
Initially observation in neurodisability clinic and reflection, then observation by consultant of trainee led clinic with satisfactory SLE
•
Observation of development assessment using the Schedule of Growing Skills (SOGS) tool (DB)
•
Deliver child development teaching to medical students (CE)
•
Observation of a Complex Physical Needs Clinic (AO,CE)
Autism clinics Learning outcomes •
Demonstrate proficiency in taking focussed history as per DSM V for ASD
•
Recognise ASD symptoms from children and YP presenting in general neurodisability clinic and knowing when and how to refer for assessment
•
Recognise the co-morbidities presenting in ASD and how to support families
7
How we will achieve this •
Initially observation in ASD clinic and reflection, then observation by consultant of trainee led clinic with satisfactory SLEs
•
Attendance in ASD MDT and reflection
•
Attendance at over 11 ASD MDT and reflection (LM)
•
Observation of specialist SLT school visit (Zoë Howe, Megan Borkwood,Sue Morley)
•
Observation of school visit with specialist nurse (AR, HF)
•
Observation of ADOS (FB, LD, AN, AO, JD)
Looked after children clinics Learning outcomes •
Demonstrate proficiency in assessing the health needs of looked after children and young people
•
Formulates a plan for health needs and communicates this effectively
•
Formulates a summary of implications for that CYP and communicates this effectively
How we will achieve this •
Initially observation in IHA clinic and reflection, then observation by consultant of trainee led clinic with satisfactory WPBA (CE,SS,FB,CC,LD)
•
Independent IHAs
•
Attendance at adoption panel (AO,AN)
•
Attendance and observation of LAC nurses
•
Observation of Children in Care team at CAMHS
8
Additional learning opportunities and multiagency working In addition to the three main threads, there are 7 areas of additional learning opportunities which you can access. This placement is one of the few where you have autonomy over what you learn and work with other professionals. Plan your time wisely to learn from other colleagues and education sessions in these 7 areas: 1. Therapy 2. CAMHS 3. Education 4. Integrated Care Board 5. Safeguarding, Social Care and Child Death 6. 0-19 Team 7. Palliative Care and Complex Neurodisability Children’s Therapy Services Learning outcomes •
Works effectively with other agencies to support and manage children with neurodevelopmental conditions
How we will achieve this •
Observation of physiotherapy clinic and reflection
•
Observation of occupational therapy and reflection
•
Observation of speech and language therapy and reflection
Child and adolescent Mental Health Services (CAMHS) Learning outcomes • Identifies symptoms of mental health conditions (e.g. ADHD, anxiety) and recognises when to refer to colleagues How we will achieve this • Observation of colleagues in CAMHS including: o Single point of access triage / Branching minds o Cognitive assessment with LD nurses at CAMHS o ADHD clinic and online case meetings with CAMHS o Eating disorder clinic o Mood – Assessment and Primary Intervention Team (APIT) •
Completion of e-learning for health on Mental Health
9
Education Learning outcomes • Understands the role of education in supporting children in both early years and school age How we will achieve this • Observation of SENCo Integrated Care Board Learning outcomes • Understands role of ICB and has oversight of strategic meetings How we will achieve this • Attendance at management meetings Safeguarding, Social Care and Child Death Learning outcomes • Recognises signs of abuse and neglect and understands the pathway for referral to social care • Understands the role of social care • Understands the CDOP process How we will achieve this • Observation of child protection/Section 47 assessments in acute paediatrics • Attends and observes SARC at SCH • Attends strategy meeting • Attends case conference • Attends CDOP meetings • Observation of safeguarding nurses • Completion of internal safeguarding teaching (eg. hidden males) • Completion of external safeguarding teaching at Barnsley POD (eg. domestic abuse, neglect, ACEs) • Completion of e-learning for health modules (eg. FGM) 0-19 Public Health Nursing Service (PHNS) Learning outcomes • Understands role of 0-19 team and how we work together How we will achieve this • Observation of Health Visitor • Observation of School Nurse
10
Palliative Care, Neurology and Complex Neurodisability Learning outcomes • Demonstrates proficiency in assessing the health needs of children and young people with complex neurodisability in a systematic fashion • Demonstrates an understanding of the needs of families and CYP with medical complexity • Understands role of palliative care in paediatric population How we will achieve this • Attendance and observation of a Complex Physical Needs Clinic (AO,AN) • Observation of Martin House palliative care team • Observation of Bluebell Wood Hospice • Completion of Respect/ ACP training package (www.togetherforshortlives.org.uk) • Contribute to writing an ACP (CE) • Attendance and observation of tertiary services in neurodisability and neurology (at SCH) • Observation of Community Nurses / SCH Palliative Care Team on visits (CE & Fay Nolan)
• Review and reflection on complex care – visit colabpartnership.org.uk Professional meetings to discuss safeguarding concerns and complex needs reviews Finally, there will be ad hoc meetings which are often arranged as an emergency or at short notice which we cannot plan for. It is really important that you do try and attend these, so keep your ear to the ground about them and be bold and ask to attend if you hear of any. I will also send you invites from my calendar to join virtually. The meetings you can join include – 1. 2. 3. 4. 5. 6. 7.
Strategy meetings Child Protection (CP) and Child in Need (CiN) meetings Team Around the Family (TAF) or Early Help SENCO meetings Complex Care MDTs and discharge planning meetings Joint Agency Response (JAR) following a child death Complex transition
We hope that it all goes to plan – as you know this is quite a new post so please give us honest feedback about how you found it, what worked well and what didn’t. On behalf of the team at Barnsley Community Paediatrics, thank you and we look forward to working with you,
Dr Claire Enevoldson
11
Training Expectations Community Paediatrics is a very different department to acute paediatrics – you have far more autonomy over your learning, where you are expected to be and more admin time than before (and you don’t have a bleep) We have to find a balance between booking you into clinics every day, and letting you make decisions about your own learning needs – we trust that you will not take liberties whilst you are here and unsupervised, and that you use your study/admin time wisely. This will be evidenced by reflections and WPBA on your portfolio – no evidence on our portfolio means that your supervisor cannot show you are competent, and therefore would need to raise concerns with your ES/ARCP about your progress. If you struggle with putting things on your portfolio please speak to your CS about how they can help. Despite being in the placement for 6 months, factoring leave, sickness and study leave, as well as your oncall commitment you will spend far less time actually here in the department. It’s important for you to actually look at how many days you are here and work out what you need to achieve in your time. The competencies guideline that we provide at induction tells you what is expected of you and how you can meet those competencies. We want you to feel competent and confident after your rotation here, as there are many skills you can learn that are relevant for any paediatric future career, be that neonates, general paediatrics or sub-specialties.
We expect you to: When you do not have a scheduled clinic: 1. Use your initiative to arrange education opportunities when not booked in to clinic – the list we provided at induction under ‘booking opportunities’ is everything that we would expect you to book onto. Some are whole days – e.g. 0-19, but others are only half day, e.g. ADOS. Most clinics at New Street are in the morning – please bear this in mind when booking on to other things. Please ensure that you make regular useful reflections in your portfolio throughout the rotation about these sessions. 2. When you have admin/study time please use this time for relevant QI projects or e-learning opportunities as listed in the induction folder. Again, reflections on these will be expected at the midpoint and final meeting. Admin and logistics: 1. Keep your Outlook calendar up to date with annual leave, study, on calls, swapped days etc. inform Nicki of any additional opportunities booked onto. 2. Inform your CS, HR, the admin team and the Consultant in the clinic you are expected in of any sick leave or emergency leave. 3. Verify your dictations promptly. 4. Inform us of any experiences you feel are difficult to obtain, wrong contact details, etc. 5. Inform us if you feel that you are being booked in to the same clinics so that we can vary it.
12
Prior to your scheduled clinic: 1. Review the notes before clinic to familiarise yourself with the CYP – you can do this by looking at Mediviewer the day before > recent clinics > date > search the code (listed in the ASDAT office behind Nicola’s Desk). On the day of your scheduled clinic: 1. Be in the department at 9am to meet with the consultant – time management is a very important habit and lateness will be reflected on your MSF and CS report. 2. Make a positive contribution to clinics you are observing – offering to examine or play with children if you are not undertaking the history, asking questions, reading up on conditions seen etc. 3. Ask to see the children supervised during the clinic if this is not offered. 4. Request SLE, eg. mini-CEX, CBD afterwards and use this as a learning opportunity to develop your skills. 5. Use the templates provided in the induction folder to help structure your clinics and letters.
You can expect us to: 1. Arrange a varied teaching programme with the timetable sent out the week before. 2. Offer meaningful SLEs after or during clinics. 3. Provide a positive experience in clinic. 4. Offer continuity of clinical supervision. At your midpoint meeting This is where we would be expecting you to review your progress. You should have completed several varied SLEs to show that you are developing skills in the 3 main areas (LAC, Autism and Neurodisability) and that you have undertaken supervised clinics. We would also expect that you have made a start with the 7 other areas (complex/palliative, therapy, education etc) either with observations already undertaken and reflected on, or booked in for the future. If there are issues please do not leave it until this point to raise them. Take the competencies sheet with you to the meeting to share with your CS to see your progress or where you feel you need more experience. If not, what do you need to address and how can you make a plan to do this in the remaining months? Your portfolio will be reviewed – you should be showing competencies in Mini-CEX, CBD, DOC, safeguarding CBD if possible with SLEs and meaningful reflections. At your end point meeting We would hope to be able to have seen that you have met the competencies in most of the ten areas and that any issues were resolved.
13
Autism
Neurodisability opportunities
Complex Physical Needs clinic
Neurodisability Admin Office R.111 Barnsley.CommunityPaediatric1@nhs.net
✓
Neurodisability clinics
Neurodisability Admin Office R.111 Barnsley.CommunityPaediatric1@nhs.net
✓
Deliver development teaching to medical students
Ask CE for dates for this
✓
Nurse led clinics inc Down’s Syndrome
Please arrange directly with the nursing team who are located in R.101
✓
School observation with nurses
Please arrange directly with the nursing team who are located in R.101
✓
SOGS assessment
Please arrange directly with Debbie Buckingham, Specialist Nursery Nurse who is located in the Nurses Office R.101 or email Debbie.Buckingham1@nhs.net
✓
Whistle stop tour of the assessment journey.
Please arrange directly with Matt Smith, Team Leader, who is located in R.113 or email him on Matt.Smith10@nhs.net
✓
ADOS observation
Neurodisability Admin Office R.111 Barnsley.CommunityPaediatric1@nhs.net
✓
IAA clinics and ACFS Sessions
Neurodisability Admin Office R.111 Barnsley.CommunityPaediatric1@nhs.net
✓
Specialist SaLT assessments
Date Confirmed
Date emailed
Booked by You
Booked by CE
Contact Details
Booked by Admin
Learning Opportunities and how to access
Children <12: Sue.morley@swyt.nhs.uk or
Zoe.Howe4@nhs.net
✓
Young people >12: M.Borkwood@nhs.net
14
Date Confirmed
✓ ✓
CiC in CAMHS
Ellis.Mosley@swyt.nhs.uk
✓
OT and physio assessment
cate.crownshaw@swft.nhs.uk Julie.hudson@swft.nhs.uk
✓
Community SLT
Caroline.clifford@swyt.nhs.uk (other SLTs available if Caroline cannot help)
✓
CDOP observation Barnsley Town Hall
BarnsleyCDOP@barnsley.gov.uk
✓
Any CIN/CP from the consultants and nurses I will update you about
Claire.enevoldson@nhs.net Will need to request any meetings and follow up. Alternatively look at nurses notice board to book on
✓
SARC at SCH
Alexandra.fishwick@nhs.net – aim to spend the whole day on the safeguarding unit to see CP cases and sexual abuse cases
✓
Think Family Safeguarding session
Contact Medical Education to book on course (level 3)
✓
Booked by You
gemmaconway@barnsley.gov.uk
Booked by CE
CiC nurses observation
Contact Details
Date emailed
Booked by You
Booked by CE
✓
Date Confirmed
Adoption and adult medicals
Please arrange directly with the LAC Coordinators who are located in R.102 or email them on Barnsley.LACandAdoption@nhs.net
Date emailed
IHA clinics
✓
BSPanelAdministration@barnsley.gov.uk
Booked by Nicki
Safeguarding, Social Care & Child Death
Therapy
Looked after Children
Adoption panel at Barnsley Town Hall
Booked by Admin
Contact Details
15
CAMHS
APIP Clinic Observation ADHD Nurse
Dr Ovi Sandica from CAMHS will contact you in due course to arrange. We will pass you contact details to him at the start of your placement.
0-19 Team
Education
Additional CAMHS experience
SENCO meeting
Claire.enevoldson@nhs.net
✓
School Visit (West Riding)
Claire.enevoldson@nhs.net
✓
Visual impairment team
hollywallace@barnsley.gov.uk
✓
Observation of School Nurse
JoanneBissell@barnsley.gov.uk
✓
Observation of 0-19 Team
Kim.stead@Barnsley.gov.uk
✓
Any TAF meetings from the consultants and nurses I will update you about
Claire.enevoldson@nhs.net Alternatively look at nurses notice board to book on
✓
Attend Early Help Panel
earlyhelp@barnsley.gov.uk
✓
16
Any ACP meetings from the consultants
ICB
Palliative Care, Specialties and Complex Neurodisability
ENT Clinic
Claire.enevoldson@nhs.net will share information with you when available. Speak with Shirley or
Barnsley.CommunityPaediatric1@nhs.net
✓ ✓
Genetics clinic
sheffield.clinicalgenetics@nhs.net
✓
Epilepsy Clinic
Paediatric.Epilepsy@swyt.nhs.uk
✓
Audiology Clinic
01226 644803 / 644894
✓
Orthopaedics
Mr Nicolau secretary at SCH and Mr Cashman for SCH spinal clinics caron.edmonds@nhs.net
✓
Complex Transition
Claire.enevoldson@nhs.net will share any invites with you.
Palliative Care team at SCH
scn-tr.PalliativeCareTeam@nhs.net
✓
Neurology at Ryegate
– Muscle disorders, traumatic head injury, ADHD etc. scn-tr.NeruologySecretaries@nhs.net
✓
Martin House Hospice
Contact the care team to discuss observation – 01937 844836
✓
Bluebell Wood Hospice
Contact the care team to discuss observation – 01909 517360
✓
Community Nurses
Ccn.team@nhs.net – respiratory, complex care, palliative care
✓ ✓
Complex Care Team at SCH
✓
Contact to ask if you can attend MDTs for complex children – scn-tr.complexcare@nhs.net Alice.Thornton7@nhs.net Transformation and Delivery Manager for LD, ASD and Maternity Services
`
✓
Adult Learning Contact to arrange observation – mevans14@nhs.net Disability Nurse
LD & Autism
Date Confirmed
Booked by You Date emailed
Booked by CE
Booked by admin
Contact Details
✓
17
Community Paediatric Teams Please ensure you have had a good overview of Community Paediatric services by the end of the rotation. If you feel you are lacking in opportunities for core Community Paediatric competencies please contact the following people:
Clinicians Name Additional Roles
Name Additional Roles
Dr Angela Oliver (AO) (f)
Dr Claire Enevoldson (CE) (f)
Consultant Community Paediatrician and Clinical Lead & ASDAT Pathways Lead
Consultant Community Paediatrician and Palliative Care Lead and Training Lead (ST)
Dr Fiona Blyth (FB) (f)
Dr Limyaa Mohamed (LM) (f)
Consultant Community Paediatrician
Consultant Community Paediatrician and Consultant for over 12 ASD
Dr Christine Chiong (JCC) (f)
Dr Andrea Nussbaumer (AN) (f)
Consultant Community Paediatrician
Consultant Community Paediatrician and Designated Doctor for Looked After Children
Dr Lizizie Dierckx (LD) (f)
Dr Sarah Sloan (SS) (f)
Consultant Community Paediatrician
Consultant Community Paediatrician and Named doctor for LAC
Specialist Neurodisability Nurses Name Additional Roles
Name Additional Roles
Terrie McNiffe
Andrea Robinson
Lead Nurse, Neurodiability and Sleep Medication.
SEND, Neurodisability, T21 and Sleep Medications.
Helen Fagg
Debbie Buckingham
Transition, Neurodisability and Sleep Medications.
Specialist Nursery Nurse and SOGs Assessments
18
Autism Assessment Team Name Additional Roles
Name Additional Roles
Matt Smith
Megan Borkwood
Specialist Autism Practitioner and Team Leader
Specialist Speech & Language Therapist for ASDAT
Zoë Howe
Ruth Mappin
Specialist Speech & Language Therapist for ASDAT
ASDAT Coordinator for Drs Dierckx, Enevoldson, Nussbaumer, Sloan
Nicola Whitham
Karen Brookes-Drumgoon
ASDAT Coordinator for Drs Blyth and Mohamed
ASDAT Coordinator for Drs Chiong and Oliver
Brenda Littledyke Secretary to Specialist SaLTs
Looked After and Adoption Team Caroline Fox
Emma White
LAC Coordinator
LAC Coordinator
Neurodisability Team Shirley Higginbottom
Caroline Fox
Team Secretary to Drs Blyth, Dierckx, Enevoldson, Mohamed, Sivaramakrishnan and Tumi
Team Secretary to Drs Chiong, Nussbaumer and Oliver
Emma White Team Secretary to Drs Chiong, Nussbaumer and Oliver
Community Typists/Clerks Donna Leung
Maxine Wilson
Community Typist/Clerk
Community Typist/Clerk
19
Locality Teams for Neuro-Disability and ASDAT Main Clinician Nurse
Autism / ND
Dr Nussbaumer Helen Fagg
[1] Bolton upon Dearne, Goldthorpe, Thurnscoe
Dr Sloan Helen Fagg Dr Oliver Andrea Robinson Dr Chiong Helen Fagg Dr Blyth Helen Fagg
Dr Enevoldson Andrea Robinson
Autism only
Complex Physical Needs
ND only
[1] Ardsley, Billingley, Cortonwood, Darfield, Great/Little Houghton, Hemingfield, Wombwell. [1] Birdwell, Elsecar, Hoyland, Hoyland Common, Jump, Platts Common, Pilley, Tankersley. [2] Royston [3] Complex Physical Needs Clinic [1] Brierley, Cudworth, Grimethorpe, Lundwood, Shafton. [2] Carlton, Monk Bretton [1] Barugh Green, Darton, Haigh, Higham, Kexbrough, Mapplewell, Staincross, Woolley Grange [2] Cawthorne, Cubley, Dodworth Gilroyd, High Hoyland, Hoylandswaine, Ingbirchworth, Millhouses, Oxspring, Silkstone, Thurgoland, Thurlstone [1] Central area, Kingstone, Old Town, Town Centre [2] Complex Physical Needs Clinic [3] Stairfoot <12 (ASDAT only) [4] Regional Palliative care [1] Athersley, Newlodge, Roundhouse, Smithies
Dr Dierckx Andrea Robinson
[2] Gawber, Redbrook, Pogmoor, Wilthorpe. [3] Worsborough/Kendray <12 (ASDAT only)
Dr Mohamed Andrea Robinson (ND only)
[1] Kendray, Stairfoot, Worsborough and Ward Green [2] =>12 All areas (ASDAT Only)
20
Community Teaching and Meetings 1. Continued Professional Development Meetings - 2nd Tuesday / Monthly (Via Teams) Please request an invite from Andrea Robinson R.101 or Andrea.Robinson7@nhs.net 2. Community Paediatric Governance Meeting - 2nd Tuesday / alt Monthly (Via Teams) Please request an invite via Sally.Marsh6@nhs.net 3. TNC – the neurodisability team, please email to join their Teams channel for their monthly teaching theneurodisabilitycommunity@gmail.com 4. Neurology and Neurodisability Excellent free courses from the British Paediatric Neurology Courses every month Please access more details via https://courses.bpna.org.uk 5. eLearning for health courses Free online courses for a variety of subjects including; mental health, infant feeding, adolescent health, FGM, safeguarding, paediatric palliative care etc. For further details please visit www.elfh.org.uk 6. Multiagency safeguarding training Barnsley Access to training and CPD sessions for professionals working in the early years sector. If you have not used the Pod before, you will need to request an account by emailing support@learningpool.com or calling 03450 744114. The Pod can be accessed at https://barnsley.learningpool.com/ 7. NSPCC Database of Serious Case Reviews to read and reflect on https://learning.nspcc.org.uk/casereviews/recently-published-case-reviews Newsletters for safeguarding updates https://learning.nspcc.org.uk/newsletter/caspar
8. Paediatric teaching at BDGH - currently running remotely Monday SHO teaching, Tuesday 4pm teaching including safeguarding and M and M, Thursday journal club 9. Grand Round Webinars – RCPCH Free webinars on a Friday lunch time. www.RCPCH.AC.UK
21
Alternative Resources for Understanding Neurodiversity (if you have limited time – please read The Curious Incident and watch the Paddy and Christine McGuiness documentary)
Books Non-fiction • Neurotribes – Steve Silberman • M is for Autism – Vicky Martin • Martian in the Playground – Clare Sainsbury • The reason I Jump – Naoki Higashida • Women and Girls with Autistic Spectrum Disorder – Sarah Hendricks Fiction • The Curious Incident of the Dog in the Night Time – Mark Haddon – fantastic book about a teenager with autism • Eleanor Oliphant is Completely Fine – Gail Honeyman – brilliant book about childhood trauma and adulthood • A Kind of Spark – Elle McNicoll
Films and TV Shows • • • • • •
Our Family and Autism : Paddy and Christine McGuinness – Iplayer Best Interests – Iplayer series about complex care and end of life ethics Atypical – Netflix series about an autistic young person Life Animate – Netflix Love on the Spectrum – Netflix Speed Cubers – Netflix
Podcasts •
The Skies We’re Under
22
Clinical Letters – advice and guidance for Trainees Tips ✓ Check it is recording with sound (unplug webcams as they affect the sound recording quality) ✓ Speak clearly and not too quickly Start of dictation - Patient’s name, unit number, DOB - Who their consultant is - Type of letter: area (if not at New Street) and face to face/telephone/video - New patient or follow up - The majority of letters should be addressed to GP or original referrer Content - Problem list - Medications – name, dose (not volume). Check with parents as the doses may have changed since the last appointment. Useful to identify if shared care agreement with the GP for prescribing Melatonin and consider starting one if not. - Education setting - name (school/nursery) or ‘not in setting’. Include if child has any additional support, Education and Health Care Plan, MyPlan - Document if child is in receipt of Disability Living Allowance (DLA) or Personal Independence Payment (PIP) and whether they access any respite. -
History - There is a history template used by the nurses which you may find helpful if new to community paediatrics. - The Health, Wellbeing and Functioning assessment has some suggested structure as well (https://www.svpr-asrp.ch/files/u1/HFWSummary.pdf)
-
Examination - Include height, weight, OHC and centiles. There should be growth charts in the notes, if not the WHO has a free app which you can input data to and it calculates the centiles for you (corrects for prematurity). It also calculates the BMI and standard deviations above the mean, useful for obesity management. Please do not omit the head circumference centile – this is very important **If there are safeguarding concerns, e.g. a child on a child protection plan, you must complete a full physical examination - see Serious Case Review on Peter Connelly using this link www.basw.co.uk/system/files/resources/basw_111257-10_0.pdf
23
-
Summary, plan/follow up - Please be clear about follow up when, where, who and what type (face to face, telephone or video) Consider if the patient would be suitable for a nurse led clinic as follow up, or to discharge the patient.
Who to copy the letter to - It is essential that letter is copied to MDT – o Medical teams - parents will know who they are under, e.g. gastro, neurology. Check with patient and families who they see, things change. If you can state the name of the professional, role and where they are based – e.g. Dr Ugonna, Respiratory Consultant, SCH, this is very helpful for the typists. o Nursing teams – e.g. community nurses, hydrocephalus nurses, continence specialist nurses o 0-19 services - named HV if under 5, school nurse if over 5. The family may also have a named Family Support Worker o SENCO - with consent from parents o Social Worker if CIN or CPP, or disability social worker o Palliative care team at Bluebell Wood o Allied health professionals such as SLT, OT, Physiotherapy, CAMHS, VI team - It is good practice to copy parents/carers in to the letter – you can ask them if they would like a copy in clinic. Referrals or requests from other teams (e.g. SLT or neurology etc) -
-
-
These can be dictated at the end and will go at the bottom of the clinic letter, or as a separate dictation and letter. Be mindful about what it is you are asking for from other specialties and how they can contact you for more information Internal referrals to ASDAT for autism referrals do need a separate letter, please send a brief summary of your concerns and a copy of the clinic letter. (Internal referrals to ASDAT do not need an Early Help Assessment starting by you but it would be good practice to request the health visitor initiate one. Requests for information from SLT can be made via a generic email address with the child name and DOB – swy-tr.barnsleyspeechtherapy@nhs.net Some teams have their own referral pathway, criteria for acceptance and e-form which are all available online – these are: Audiology, SLT, Physiotherapy, Occupational Therapy, Orthotics
24
Additional correspondence to send with letter If you need to send extra paperwork with the letter – eg. genetics form or printed seizure diary for parents to fill in, please attach to the notes and dictate at the end of the letter what is needed to go with the letter. Was Not Brought (WNB) 1) Try to contact parents via the phone it maybe possible to do a telephone clinic depending on the patient and time and decide if needs rebooking. 2) If you are unable to contact review the Paediatric WNB guideline on the intranet and complete the Safeguarding WNB proforma as part of this to keep in the notes. This identifies if there have been other missed appointments. 3) If there are safeguarding concerns it is essential that these are escalated as it may indicate that a child’s medical needs are not being met and this information needs so be shared amongst professionals. You can contact the: Named health visitor via 0-19 service – 01226 774411 Social worker via the assessment service – 01226 772423 Safeguarding Nurses at BDGH 4) When you dictate a letter stating the WNB please ensure that it is copied to the relevant MDT. Top tips for clinics Before clinic • Read through notes and last clinic letters prior to clinic • Chase any outstanding results as you don’t have a PC in clinic room • Think about how you might action any concerns in advance and who you might refer on to • Think about other professionals you might want the letter to go to and whether parents might have the contact details – e.g. specific FSW name • Consider if you need to look on SystmOne for updates from social care or HV team After clinic • Upload dictation and fill in demographics (unit number and name) and what type of letter it is, ND clinic, ASD feedback, LAC etc • Log into Careflow (same log in details as main PC) and complete outcomes (SEE BELOW FOR EXAMPLE). Once clinic list is up right click on each patient to complete time seen, clinic method, book appointment now, coding and follow up, e.g. +3m, +6 months. Don’t forget to add interpreter if needed.
25
• •
Add all items to be posted to families with the letter to the notes – e.g. Genetics form, post diagnosis leaflet Return notes (purple notes) to secretaries for digital filing Outcoming Clinic 1. Select ‘View Patient Reception’ from the Out Patients tab on the left-hand side of the screen. 2. Select the venue name for where the clinic took place and then clinic refresh.
3. Find your patient on the list, right clinic and select clinical outcome
26
Dictation advice If you are experiencing difficulties with Winscribe (digital dictation) please contact the clinical systems helpdesk on 01226 432771 Initial information When starting a new job, please complete as much information as possible on the front screen as this helps the typist ensure they have the right patient. If using a digital pocket mic (one of the silver portable ones) you have to add this post dictation. Where possible, it would be a massive help if you could identify in the comments box what type of clinic this is for eg, LAC, ACFS, IAA, ND Clinic, Enuresis etc…….. this will ensure the right person is picking up the right work rather than having to listen to the start of each recording to see what it is.
Please ensure To.. section is set to Paediatric New Street
Speech Please try to speak slowly (ish) and clearly keeping the mic close to your face to ensure good sound quality. Spell out any unusual names or unfamiliar medical terminology.
Copies to When asking for copies to, it would be really helpful if the person named is not a familiar member of staff or a regular contact for the team then as much detail is given about the person eg, Copy to Dr Adam Rennie who is a Consultant Interventional Neuroradiologist at Great Ormond St Hospital or SENDCo at Wakefield Girls High. This would be a massive help as we have occasions where typists/secretaries are spending a significant amount of time telephoning and googling other services to try to find out the correct details.
27
If you are naming a person with an uncommon name, it would be helpful if these could be spelt out, especially where pronunciation is difficult as it is hard to search on the system for people when you can’t hear what is being said. It would also be very helpful if this information could be given at the start of the dictation please rather than the end as this is when we have to enter it on the system – although this isn’t a major issue it would still save us time having to go back to change this. Please do not add, amend or delete contacts yourself when verifying as this will not be picked up by the electronic distribution system meaning the letter will not go to the intended recipient. If you need to add someone on after, please speak to the typist who can do this for you.
Attachments/enclosures It would also be useful to know at the start if you intend to add attachments to this document – eg, other reports, booklets, forms, as this determines how we set the first part of the document up and how it is distributed (automatically or manually). Currently we have to close a job and go back to the beginning to the add ‘yes’ for attachments. However, specific details of the attachment can be given at the end. Again, please do not manually add these post typing, speak to the typist.
Priority / Non-priority Please only mark jobs as a priority where necessary.
Post Scripts If you have a very short PS, then this is OK to be added to the bottom of the letter however if you are dictating quiet a lengthy PS, then please could this be done as a separate dictation/document otherwise we aren’t getting an accurate reflection of the work coming into the team. There have been some cases where a clinic summary has 3 or 4 lengthy PS’s on the bottom which is more or less a letter with a letter – on our system it would just show 1 letter typed which took a long time rather than reflecting the actual 4 letters and the true time taken (sorry if that doesn’t make sense).
Notes Once dictated, please ensure the purple / buff notes are passed to the relevant secretary for scanning.
Named consultant patients If you are seeing the patient on behalf of a consultant, state this at the start of the letter “this is a Dr XX patient” – again this just saves us having to search for details.
28
Internal Referrals to ASDAT Internal referrals to the ASDAT pathway are done so using an eform available via the Trust’s Hub. A consultant or member of the ASDAT team will be happy to show you how to access this if needed. All referrals should be discussed and agreed with the named consultant prior to submitting.
Formatting Please be mindful when changing font types, sizes and formats, adding colour or boxes as we have a corporate branding guide to follow, also it creates an inconsistency in presentation across the department. On behalf of all my wonderful team, thank you for considering the above and please do not hesitate to ask me should you need any clarification on the above points.
29
Onward Referral Advice Team
How to refer
Where to find up to date form
Speech and Language
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
www.barnsleyspeechtherapy.co.uk
OT and Physio
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
0-19 Service
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
Audiology
Paper referral, leave with notes and secretaries will send off
Paper referral in consultants and nursing staff offices
Orthotics
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
\\storage01\clinicians
Orthopics / Ophthalmology
eform
Disabled Children’s Team
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
Learning Disability Nurse (Transition)
Referral letter, phone or email – details on intranet
Continence Team
parents can self-refer \\storage01\clinicians
Portage
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
Community Nurses
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
\\storage01\clinicians
\\storage01\clinicians > Referral Forms > children’s therapy *Parents can self-refer \\storage01\clinicians > Referral Forms > 0-19 referral form
> Referral Forms > orthotic referral
Parents can self-refer
Referral Forms > portage form
> Referral Forms > CCN
30
Bluebell Wood
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
Tier Three Weight Management
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
Community Dentist
Online form which secretaries will then email for you or you can email it yourself, keep copy in notes
www.bluebellwood.org
\\storage01\clinicians > Referral Forms > weight management
\\storage01\clinicians > Referral Forms > community dental referral
Written referral letter Epilepsy Clinic
EEG request goes to RHH – you can email or ask secretaries upload a copy to medical notes.
\\storage01\clinicians > Referral Forms > EEG
Schedule of Growing Skills Assessment
Community Neurodisability Nursing Team eform
Trust Hub > EFORMS > Community Paediatrics
CompassB
A local mental health support team who work in schools to support MHS to pupils
Parents can self-refer or you can ask to discuss with the school link worker.
Specialist Nurses
Community Neurodisability Nursing Team eform
Trust Hub > EFORMS > Community Paediatrics
ASDAT
Internal referral paediatric autism form (eform)
Trust Hub > EFORMS > Community Paediatrics
Referrals to be made via Branching Minds service.
www.southwestyorkshire.nhs.uk/services/camhsbarnsley
**Parents can self-refer
Parents can self-refer
CAMHS
31
Requesting Investigations • • •
Please chase up results you have ordered and act on them – e.g. Starting vitamin D or Sytron Add patient to your list on ICE to keep track of results, so you know to chase them +/- a private note to remind you what you ordered and when you requested it from families When leaving the post please tell us what investigations you have outstanding How to request
WGS
MRI
How to chase
Please discuss with the named doctor for the patient Get written consent on same day if you think it might need doing in the future – saves bringing the family back to sign it.
OpenICE
**GA requires 2 forms, check with consultant first.
Venous bloods, urines and EDI screen
USS / CT
Request Bloods QR code to be added to clinic summary – this gives parents info on booking
ICE
Request bloods on ICE under the consultant’s name ICE
ICE
Paper form on X Drive, print out and fill in Echo
EEG
OpenICE Give to secretaries who will email to SCH Paper form on X Drive, fill in and email to Neurophysiology on the address at the top on the referral form, admin team can help
Sent by external post
32
Useful acronyms ADOS = Autism Diagnostic Observation Schedule (a semi-structured assessment for children with suspected autism, usually if they are borderline as to whether they meet DSM-V criteria for diagnosis) ASDAT = Autism Spectrum Disorder Assessment Team (MDT panel involved in assessing autism – usually consists of community paediatrician, OT, SENCO, SALT). Note: assessments can be arranged routinely or through EMDT process, which is quicker and tends to be used if diagnosis is more obvious) ASQ = Ages and Stages Questionnaire (developmental screening tool used by health visitors/early years practitioners, relies on parental answers to questions) EHA = Early Help Assessment (assessment process to identify needs of family, led by any professional that knows family best, MDT meet to develop action plan) EHCP = Education, Health and Care Plan (outlines a child’s special educational needs and the provision the LA must put in place to support them). EP = Educational Psychologist (based in LA, work with schools to complete assessments and provide advice on how to meet the learning needs of children with special educational needs (SEN) – useful for obtaining an EHCP) FSW = Family Support Worker (work with families on specific intervention for specific period of time e.g. 18-24 weeks) ICO = Interim Care Order (allows LA to share parental responsibility with parents whilst a decision is made about the child’s future. Lasts 8 weeks. These children need a medical within 20 days) LAC = Looked After Child (in care of LA – may be looked after in a children’s home/foster care/by other family members) SCI = Social Communication and Interaction team (based in local authority (LA), work within educational settings to provide strategies to help children with communication difficulties e.g. ASD) SOGS = Schedule Of Growing Skills (developmental assessment tool, children observed doing a range of activities) TADS = Therapies for Anxiety Depression & Stress (charity that runs workshops and 1:1 sessions for young people aged 5-25yrs to help with emotional wellbeing, accessed through schools/self-referral) TAF/TAC = Team Around Family/Child (MDT meeting arranged as part of EHA, usually involves school, 0-19 service (health visitor or school nurse) +/- family support worker)
33
Community Neurodisability Clinic History – new patient Presenting complaint Reason for referral – who and why Child and parent/carers concerns – since when, effect on child/family Other professionals involved – are concerns shared (including education) Birth History Pregnancy: -
Maternal health, medications, foetal movements and growth, scans Smoking, alcohol, drugs Domestic abuse, antenatal stress
-
Gestation Delivery Resus, SCBU, sepsis, jaundice etc Birth weight, IUGR Feeding Bonding, ask re PND
Birth:
Neonatal period: -
Babbly baby, alert
Past medical history -
Chronic illnesses Visits to hospital/GP Medications Allergies Immunisations
Developmental history -
Gross motor Fine motor and vision Language, communication and hearing Social History of regression
34
Activities of daily living -
Sleep Eating Toileting Behaviour
Education update School/nursery: -
attainment, progress, support (EHCP, MyPlan, SchoolFocusPlan), interaction with peers
Family and social history Parents: -
names, ages, occupation, help with learning in school, physical/mental health
Siblings: -
names, ages, health and development
Wider family (ASD, ADHD, learning difficulties, genetics) -
Any social care involvement or adverse childhood experiences which may indicate early trauma, eg. neglect, domestic violence, parents incarcerated or separated, abuse, attachment etc.
Examination General appearance -
dysmorphic, birth marks, neurocutaneous markers, injuries or bruises, Woods lamp interaction with caregivers and professional: eye contact, smile, conversation, play
Growth parameters - height, weight, OHC and centiles Systems examination including neurology and MSK (look for hypermobility) Developmental assessment summary if under 5
35
Investigations -
Blood tests – most requested on ICE as ‘developmental panel’, genetics form will need to be given to parents or send out with clinic letter
-
MRI – GA or non GA form (2 parts – request form and consent form, both must be filled in) complete with parents as you need their written consent for this.
-
EEG – form is available on the intranet – complete and give to secretaries who will kindly email and print out a copy of the email for the notes
-
Checklist and info from school/nursery – send brief letter with information you want and ask for checklist to be enclosed with the letter
Summary and plan Ask re copying letters to other professionals including education
Best Practice Article| Developmental examinations: birth to 5 years Available to view on the shared drive for Junior Doctors: \\storage01\schoolhealth\Junior Doctors CCH Induction\Recommended Reads
36
Undertaking an Initial Health Assessment TRAINEE QUICK GUIDE • CHILDREN IN CARE HEALTH APPOINTMENTS
Child health assessment forms Initial health assessment (IHA) • Consent • Health planning What changed?
The 2025 review aimed for focused templates that support digital working, reduce duplication and enables a child-centred, developmentally appropriate appointment. There are three forms to fill in – with emphasis on collating information about the child beforehand, typing into a form as you do the appointment, and summarising after the appointment. All three forms are then shared to provide a comprehensive assessment.
1. The IHA pathway at a glance Stage
What trainees need to know
1
Notification
Social care informs health when a child enters care. CoramBAAF recommends a locally agreed digital process, expected within 24 hours.
2
Referral and consent
Referral form completed by the social work team and sent to the identified health service within five days. One form per child.
3
Build the health history pre appointment
Health team compiles information from records, referral, family, maternal and neonatal sources before the appointment where possible and inputs this information on the IHA-H Health History Form.
4
Choose the right template
Appropriate IHA-A Health Appointment Form selected by age/development and needs, including options for additional needs or an unaccompanied asylum-seeking young person. Form is prepopulated and saved under the child’s name.
5
During the Health appointment
Use the form as an aide-memoire, not a script. Make the encounter conversational and child-led – use a laptop and open the document to make notes as you go – IHA-A Heath Appointment Form
6
After the appointment: Health plan and sharing
Summarise needs, implications, actions and health promotion using the shared templates and scripts. Generate new ‘implications summary’ if none are available on the shared document. Share appropriately and store securely – HP – Heath Plan Form
Before the IHA appointment Review essential documents: referral and consent; health history; parental health information (PH or equivalent); maternal and neonatal information (M and B or equivalent). Helpful additions: carer questionnaire and young person questionnaire. These are requested when the IHA referral is made but it is possible you may not have them. Prepare the health history from available records in advance. This reduces repeated storytelling, preserves important history and makes better use of appointment time – you should have access to SystmOne for this, and Mediviewer. Beware out of area children may have very little information. Critical information may include family and neonatal history, antenatal factors, trauma and adversity, development, mental and physical health, safeguarding concerns and risk factors relevant to screening The LAC team will prepopulate as much as they can. This is all added to a working document – IHA - ‘Heath History Form’
37
PAGE 2 • RUNNING A CHILD-CENTRED HEALTH APPOINTMENT
2. At the IHA – complete as you go and structure the consultation without turning it into a checklist CONNECT Introduce yourself, clarify who is present and explain why the appointment is happening.
ENGAGE Break the ice. Use age-appropriate conversation, games or pictorial aids where helpful.
EXPLORE Let the child or young person lead where possible. Draw on the preprepared history rather than asking them to retell everything.
INCLUDE Involve the carer, parent or social worker appropriately, while offering the child or young person time to speak privately.
EXAMINE Explain proposed physical checks and seek agreement before proceeding.
PLAN Identify areas needing further exploration, decide whether additional tools or referral are needed, then agree a clear plan.
3. Recording the appointment The LAC admin team will have selected the template that best matches age, developmental stage and individual circumstances. The forms include prompts for trainees but experienced practitioners may not need every prompt – this is called the – ‘IHA – A (0-5, 5-11, 11- 18) - Heath Appointment Form’ saved under the child’s name. Do not mechanically work through every question. Use the sections as a background framework and record information obtained naturally through conversation. Use additional screening tools only where clinically appropriate and in line with local pathways and licensing requirements. CoramBAAF does not recommend one universal developmental screening tool for these appointments. If detailed developmental evaluation is required, refer to the appropriate paediatric service rather than trying to complete a comprehensive evaluation within the health appointment.
4. The health plan: your key output – implications and health plan This is called the – ‘HP – Health Plan’ and is saved under the child’s name CONTENT Summarise current health info Consider implications now and in the future Review the full health history and social care information Consider the impact of trauma Add actions, ownership and healthpromotion advice
COMMUNICATION & SAFETY Pre-populate relevant information where appropriate – this can be done ahead of the appointment Discuss the plan with the child or young person and those attending – may be relevent to share with social worker via email if they did not attend Involve young people in information-sharing decisions where possible Keep confidential material in the secure section of the health record – LAC team can advise Use a separate clinical letter for advice not suitable for the child-facing plan
After the appointment Review the documents with the consultant. Share the health plan, health history and appointment record with the child’s social worker and GP. The health plan is normally also shared with the young person and carer. Follow local policy for wider sharing and storage, the LAC admin Team can advise.
38
PAGE 3 • REVIEW HEALTH ASSESSMENTS, CONSENT & INFORMATION SHARING
Permission: practical principles Topic
Key point
Appointment
Permission is needed for the child or young person to be invited to and seen by a health professional. An IHA includes physical examination.
Young person’s decision
Where a young person has capacity, the social worker should discuss the appointment directly with them and seek permission; verbal assent may be recorded.
Parental responsibility
Where the child cannot decide, permission may come from a person with parental responsibility. Where the local authority holds or shares parental responsibility, submission of the referral is sufficient to proceed.
Parent health data
Birth parents must consent to their relevant health information being obtained, viewed, recorded and shared.
Ongoing review
Initial permissions may apply through the care episode, but practitioners must remain alert to changes in parental responsibility, capacity or delegated authority.
Prepare the child or young person: Explain the purpose, benefits and what will happen. Provide accessible local information with the invitation and address anxieties before attendance.
7. Information handling Avoid unnecessary duplication: if required information already exists in another suitable social care document, it may be supplied instead. Keep the longitudinal health history easily accessible throughout the child’s time in care. It contributes to future summaries, including the care leaver’s health summary. Parental health and maternal information should not sit openly on the child’s health record; local systems should use an appropriately restricted area accessible to the looked-after children health team. Use secure transfer methods. Local protocols must state where completed documents are stored in both health and social care systems and how out-of-area moves are managed.
8. Final trainee checklist ☐ I understand the legal/consent position
☐ I have reviewed and updated the health history before the appointment – IHA Heath History Form
☐ I have prepared the child or young person at the appointment and discussed their needs, examination etc – IHA Heath Appointment Form
☐ I will use the form flexibly and offer private conversation where appropriate.
☐ I will explore implications and priority needs and make a clear plan – HP – Health Plan
☐ I will share, store and protect information in line with local policy.
Example form| IHA Parc C Available to view on the shared drive for Junior Doctors: \\storage01\schoolhealth\Junior Doctors CCH Induction\Example forms
39
The Email Charter Developed by TED’s Chris Anderson and Jane Wulf, the Email Charter is a manifesto for digital humanity, for spending less time on email, and for cutting each other some slack. Respect Recipients’ Time Make your email easy to read: use these plain English tips to save others time AND make your communication more effective. Short or Slow Responses are Not Rude It's ok to be brief. Don't take brevity personally and know that others won't. Wordy responses take longer to read. People will scan it and are less likely to read it all; key details can be easily missed. Make Subject Lines and Content Clearer Start with a subject line that clearly labels the topic. Try including a status category [Info], [Action], [Time Sens] [Low Priority]. Use crisp, muddle-free sentences. If the email has to be longer than five sentences, make sure the first provides the basic reason for writing. Avoid strange fonts and colours. Stop Open-Ended Questions It is asking a lot to send someone an email with four long paragraphs of turgid text followed by “Thoughts?”. Even well-intended-but-open questions like “How can I help?” may not be that helpful. Email generosity requires simplifying easy-to-answer questions. “Can I help best by a) calling b) visiting or c) staying right out of it?!” Slash Surplus cc’s Only CC someone who really needs this message. Don't thoughtlessly 'Reply all': choose individual recipients. Tighten the Thread If you need to include the email trail showing the context, cut what's not relevant. If it's long, summarise or make a phone call instead. Reduce Attachments Don’t use graphics files as logos, or signatures that appear as attachments. Time is wasted trying to see if there’s something to open. Even worse is sending text as an attachment when it could have been included in the body of the email.
40
Give these Gifts: EOM NNTR If your email message can be expressed in half a dozen words, just put it in the subject line, followed by EOM (= End of Message). This saves the recipient having to actually open the message. Ending a note with “No need to respond” or NNTR, is a wonderful act of generosity. Many acronyms confuse as much as help, but these two are golden and deserve wide adoption. Cut Contentless Responses You don’t need to reply to every email, especially not those that are themselves clear responses. An email saying “Thanks for your note. I’m in.” does not need you to reply “Great.” That just cost someone another 30 seconds. Should we expect an instant response? Don't feel you need to give an instant response, and don't expect to get one. Skype or the telephone are your tools if something is urgent. Disconnect! If we all agree to spend less time doing email, we’d all get less email. Consider blocking out half-days at work where you don’t go online. Or make a commitment to email-free weekends. Add an auto-responder in your off time that references this charter. And don’t forget to smell the roses.
41
Wellbeing and Burnout Being a paediatrician is a rewarding vocational career, but it is not without challenges. These can range from the clinical pressures – such as working in an environment which can be understaffed and underfunded and working long hours and night shifts, to pressures outside of work as a young professional - such as buying homes, cost of living, elderly parents, your own health needs or navigating caring for a young family or pets. But there are also specific challenges that working with children who are critically unwell can bring - the first time you have to resuscitate a baby with hypoxia, the first sudden unexpected infant death you attend in resus at 5am or the first child suffering from severe, chronic neglect. We know there are a wide range of wellbeing resources available through the Deanery and beyond to support you as trainees, and we have listed some local resources below. We would also always highlight the importance of speaking to the acute consultants after significant or traumatic events to help you process what happened and to ensure you are supported. There is a acute distressing event's policy on the Barnsley intranet now which all teams should be following to support the professionals involved. As community consultants we have been through our fair share of difficult events between us, either as trainees or consultants now, and always here as a listening and compassionate ear. We also recognise how burnout can present in our colleagues and how we can help you to recognise this as resident doctors. Knowing how to handle overwhelm, respond to your spiralling workload, and thrive at work are critical skills and we can support you and sign post on to resources that can help you. Burnout Resources www.youarenotafrog.com www.youokaydoc.org.uk/posts/2024/burnout-in-healthcare-professionals
Wellbeing Resources www.bma.org.uk/advice-and-support/your-wellbeing www.youokaydoc.org.uk www.practitionerhealth.nhs.uk/healthcare-staff-in-england selfhelp.cntw.nhs.uk/organisation/vivup/self-help-guides/stress www.mind.org.uk/information-support/types-of-mental-health-problems/trauma/coping-withtrauma/#CopingJustAfterTraumaHasHappened
42
Kindness in Healthcare "There are plenty of things in life that I feel somewhat unsure about but,
working as a doctor and in a leadership role in the NHS in England, I am very certain that our business is care, and improving health. And at the heart of outstanding care, is kindness. Not kindness as a soft and frivolous thing, nor as a state of being that belongs only to optimists, but as actions and decisions we choose to make every single day. There is nothing more important than this, and if we get this right pretty much everything else can follow." - Dr Bob Klaber Governments and organisations are increasingly speaking the language of kindness. That might seem surprising. Kindness has traditionally been seen as an individual virtue or character trait, or as something belonging to a realm – that of relationships – that lies (or should lie) beyond the reach of the state and other forms of collective administration. But recent years have seen a broader ‘relational turn’: a recognition that how we relate to one another – in our communities, workplaces and services – has profound implications for individual and collective wellbeing. What do we actually mean by kindness? It’s often said that you can’t manage what you can’t measure. But it’s equally true that you can’t measure what you can’t define – or at least, that measurement and definition can’t be disentangled. Ideally, the first step in measurement would be to clarify the nature of the ‘thing’ that you are trying to measure. But, often, it plays out the other way around: an indicator is chosen that then comes to represent or define the thing you are interested in. In fact, there is always an ongoing relationship between definition and interpretation, on the one hand, and measurement on the other. To measure, we need to define; but the act of measuring can also reshape our understanding of the thing we are looking at in the first place. This is especially true when we are dealing with a complex, relational concept like kindness – something that exists in the space between people, in what passes between them and how it is understood, rather than as an easily identifiable and countable entity. Let’s consider some of the ways in which the term is used. Sometimes it is used to describe an individual character trait (“her kindness was her greatest quality”); on other occasions, a quality experienced in our encounters with one another or with organisations (“the nurse was so kind in the way he dealt with my father”), or a value that emphasises the importance of the relational in our personal and professional lives and in our encounters with services (“we aim to treat all of our service users with kindness and compassion”). But it can also be used to denote a more concrete or tangible set of practices – as consisting in the things that people do for one another (both practically and emotionally) in response to moments of perceived need, when there is the option to do nothing. That last element can also be taken to indicate that kindness can’t be mandated and that, by its very nature, it has an ‘extra’ quality that allows us to recognise it in the first place and gives it an emotional charge.
43
There are also other things that may be distinctive (and therefore useful) about kindness, but which may also have implications for how it might be measured: • Kindness isn’t ‘grand’. Unlike compassion, it has an everyday quality. While it involves a response to perceived need, it does not necessarily involve suffering. Unlike care, it does not necessarily imply an ongoing relationship or any sense of duty or obligation. • Kindness is often fleeting, growing out of interactions and encounters that are not necessarily planned or completely prescribed, and may not always be memorable or visible – even to those directly involved. • Kindness is unstable: not fixed but fluid. What starts out as a spontaneous or unobligated act of kindness can easily tip into something else – duty, reciprocity, expectation and so on. • Kindness is subjective. We cannot claim kindness for ourselves. Whether an act or a person can be considered kind can only be determined by the recipient. • Kindness is inherently relational. It is jointly ‘constructed’ at particular moments, in specific contexts, between individuals. The ‘meaning’ of that moment or relationship is not self-evident nor even fixed. As such, kindness is not an easily countable ‘thing’ in any obvious sense.
Kindness is a choice of action we can all take, role model and lead on. There is a great evidence-based and the impact of kindness on patient outcomes and self-wellbeing. Kindness is a starting point for everything critical and work to improve quality equality safety and productivity. Where these four behaviours are widely present in healthcare organisations care quality, staff wellbeing, team-working and financial performance are markedly better: 1. Attending: paying attention to staff; ‘listening with fascination’ 2. Understanding: growing a shared understanding of what the people in your teams are facing 3. Empathising; ‘walking next to people’ – feeling the distress or frustration of others without feeling overwhelmed 4. Helping; taking intelligent action to serve or help Resources www.kindnessinhealthcare.world www.civilitysaveslives.com Further Reading: Getting the measure of Kindness | Guide for organisations Located in: \\schoolhealth\Junior Doctors CCH Induction\Recommended Reads
44
Trainee Guidance for Independent Clinics in Community Paediatrics If you have a non-urgent query or you are not sure as to the correct management •
Explain to parents/foster carers/social worker that you are a trainee doctor and need to speak to a consultant before you can confirm the plan/give a clear answer.
•
When you return to New Street discuss the case with the supervising consultant (Sarah Sloan for IHAs), or if they are not available, another one of the consultants.
•
Complete your report/letters and telephone parents/social worker to update if needed.
If you have an urgent query that needs answered before the child leaves clinic •
Phone Community Paediatric secretaries on 01226 644876 (option 2) and ask to speak to the supervising consultant (Sarah Sloan for IHAs) for advice. If they are not available, ask to speak to another one of the consultants.
If you have a new safeguarding concern e.g. bruise in non-mobile child, new disclosure •
If a social worker is present (e.g. during IHA): o Keep the child in clinic. o Discuss your concerns with the social worker. They will be responsible for ensuring appropriate supervision of the child and a place of safety if needed. o Phone the paediatric consultant on call via switchboard (01226 730000) to arrange a Child Protection Medical Examination if appropriate. The social worker is responsible for ensuring the child is taken to the hospital for this examination. o Report back to the supervising consultant (or another consultant if they are not available) after clinic. o *If at any time you are unsure as to appropriate steps: Phone New Street on 01226 644876 (option 2) to speak to a consultant and/or phone the safeguarding nurses for advice on 01226 432092.*
45
•
If social worker is not present: o Keep the child in clinic. If parents/carers do not want to stay, inform them that if they leave you will have a professional duty to call the police, who will come and take the child to a place of safety. If they leave with the child, call the police. o Call Barnsley Social Care via the Integrated Front Door on 01226 772423, or out of hours via the Emergency Duty Team on 01226 787789. They will be responsible for sending a social worker to clinic to ensure appropriate supervision of the child and to arrange a place of safety if needed. o Phone the paediatric consultant on call via switchboard (01226 730000) to arrange a Child Protection Medical Examination if appropriate. A social worker is responsible for ensuring the child is taken to the hospital for this examination. o Report back to the supervising consultant (or another consultant if they are not available) after clinic. o *If at any time you are unsure as to appropriate steps: Phone New Street on 01226 644876 (option 2) to speak to a consultant and/or phone the safeguarding nurses for advice on 01226 432092.*
If you have an acute concern regarding the child’s health e.g. significant shortness of breath • Assess and manage ABC as required. •
If acutely compromised, ask reception to call an ambulance and to ask any other medical staff in the building to provide assistance (staffing will depend on location of clinic).
•
If stable but requires medical assessment, tell parent/foster carer to take the child to ED (and if it is an IHA with no social worker present, phone the social worker to update them)
If you feel unsafe during a consultation •
Leave the room and go to reception or other busy area.
•
If the situation does not de-escalate, ask reception to call the police and ensure you are in a place of safety.
46
Your notes
47
Your notes
48
Your notes
49
Your notes
50