This article reports on a patient satisfaction survey undertaken to evaluate parental perception and satisfaction of a community paediatric matron service introduced by an advanced paediatric nurse practitioner (APNP), with the intention of reducing emergency admissions of children with respiratory disease in the age range 0-16 within Eastern Cheshire Hospital Trust. The survey endeavoured to identify views and experiences of both past and present patients, in order to identify any barriers or challenges, and highlight future improvements to the service to ensure it complies with the aims identified in past quality reports and the 2010 Kennedy report into children’s heart surgery at Bristol Royal Infirmary.1
The community matron service was set up in 2006 and has successfully expanded year on year, providing quality care to children and their families. The service’s main objective was to facilitate and support children and parents to recognise the early onset of their child’s respiratory condition and to effectively self-manage each episode in order to reduce the need for admission to hospital.
The children’s National Service Framework (NSF) was a leading document that pioneered the way for the development of the community paediatric service; it advocated a shift in service provision towards children’s services being designed and delivered around the needs of the child. The aim of the NSF was to ensure that children and young people received a service that was equitable and measurable in terms of quality and met with the current NHS reforms that has seen a greater shift into the community. These aims are further supported within the High Quality Care For All NHS Next Stage Review which set out a strong message of looking at how to help the local population, patients and staff identify and make changes to the direction they perceived the NHS needed to travel.
The Kennedy report recommended that services should be a single point access, open at all times so that the child or young person can be assessed and routed to the most appropriate professional for the most appropriate treatment in the most appropriate place.
Within the community paediatric matron service, we have worked hard to become champions for the children of the Crewe area. We provide strong leadership, which assists children, young people and their families to feel they have a strong connection to a service that endeavours to provide a much-needed bridge between primary and secondary services. Unfortunately, current resources dictate that the service is restricted to patients attached to five GP practices within Crewe, and is limited to weekdays between 9am and 6pm.
The service aspires to promote positive health in a manner that ensures that families feel a sense of involvement in the way the service works, and that those offering the service are provided with a culture that is embedded in evidence-based care and the opportunities for learning within everyday practice.
Children are referred into the service for support and case management and their care is provided by an advanced paediatric nurse practitioner who works with them holistically to produce a package of care that is built around the needs of the child. This package of care can be episodic or long-term but in each case the children and families receive evidenced based care that supports the approach and aims adopted by the Kennedy report. Children and their parents receive in-depth information on their respiratory condition and any appropriate medication and treatment that is needed. The APNP works to ensure the children and families are confident with identifying onset symptoms of their child’s conditions, have the right evidence-based information and are seen in the most appropriate setting by the most appropriate person.
Since its inception, the service has been annually audited via a parent satisfaction questionnaire and the results have informed development and any quality improvements. This useful information and report ensures that children and families feel they are being provided with an equitable service that meets their needs and delivered by appropriate professionals with credible qualifications.
A questionnaire was sent out to every family on the community paediatric matron’s current case load which included those being actively managed long term, those on episodic management and
a random selection of those who have been discharged in the
last year. For parents who answered our questionnaire, we wanted to establish whether the parent had an improved understanding of their child’s health and if they felt they needed to access hospital and GP services less since their child had been involved with the service. Most importantly, we wished to elicit if they felt the service was accessible to them and what impact it would have on them, their child or family if the service was decommissioned in the future.
The questionnaires were returned to the clinical effectiveness auditing team and were anonymous to ensure there was no influence or bias to the data. The analysis from the data formed a report for the commissioners of the service in order to demonstrate the services effectiveness, quality and equity.
Results indicated that 92% of the parents who responded said they were definitely better able to cope with their child’s health needs since they had received the service provided by the paediatric community matron service. All stated that the paediatric community matron had given them more confidence to deal with their child’s health needs. 75% stated they had reduced their hospital attendance, and 77% felt they had not needed to see their GP.
The quotes provided included: “By receiving a lot more in-depth information and being able to contact the community matron for help and advice I am able to cope better with my child’s condition.”
“Being able to phone the community matron not only for emergencies but for advice is invaluable, knowing that reassurance is at the other end of the phone is excellent, and due to this my child has had fewer admissions to hospital.”
“My daughter is seven months old, and before being referred to the community matron, had seen several different GPs around nine times for the same symptoms. Since seeing the community matron we are managing things without the need for the GP’s help.”
“The community matron and I manage my child together so I use the GP less.”
“The community matron knows my child better than other health professional and knows when intervention is required”.
“I always felt the GP did not have the time to listen and provided unnecessary medication as they did not know my child, the community matron sees my child separately and provides an added service which is valuable”.
“The community matron always returns to evaluate the effectiveness of the medication”
“The service is different from the GP as there is no huge wait for appointments, the matron is able to spend more time and properly recognise the symptoms. She comes back sometimes more than once a day to re-evaluate and sees my child at home.”
“My child often gets antibiotics from the GP as a precaution as I don’t feel they have got to grips with the symptoms.”
“Home visits provide lots of useful advice”
“Last year my three-year-old was hospitalised every two weeks between January and April, since seeing the community matron for regular check-ups and being able to call when early onset of symptoms he has only been in hospital once this year and his health has vastly improved”
Suggestions made to improve the service related to increasing the hours of the service, patients would like the service to run at weekends and have late telephone support. However the service is currently run by one paediatric community matron.
It is important to recognise that this is not trying to replace the GP, which is invaluable to the community, but what practice services are trying to achieve is to complement their service. Undoubtedly without GP support, this service would not be able to function as effectively. We strive to work in a partnership communicating about the care and management provision ensuring the GPs are happy with the care pathway.
The additional factor that the paediatric community matron offers is the ability to spend more time getting to know the family and form a relationship with them so that we are familiar with their child’s condition as this is crucial in being able to act appropriately with any management we provide. Furthermore we have the advantage of delivering the service within the family home which allows us to educate on concordance of treatment and importantly evaluate environmental issues such as poor housing or parental lifestyles all of which can have a detrimental effect on a child’s health. This evidence demonstrates the difference of care allocated between GP contact and paediatric community matron.
Communication, listening and negotiation are the key themes that emerged from the parent’s responses. Parents want to be heard, they want an advocate, and they want to know that everyone involved in their child’s care knows about them and their condition. This is where the paediatric community matron service is getting it right; we keep everyone involved in that child’s care, we do regular education updates, medication reviews and correspond with the wider multi-disciplinary teams all of which form the overarching basis of a true professional advocate.
It is evident from the analysis and the verbal responses that children and their families do feel this service is different from the GP. Evidence suggests from parental feedback that Kennedy’s synopsis of GP’s overuse of medication (antibiotics) is a common theme. We empower and support parents to know when it is appropriate to access the GP, the hospital or our service. What the parents are demonstrating in this survey is that there is a time and a place where it is appropriate to access the GP - however, care closer to home can be achieved to make a child’s episode of care smoother and ultimately less traumatic.
1. Kennedy I. Learning from Bristol: The Report of the Public Inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984–1995. London: The Stationery Office; 2001.
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