By fostering collaboration and improving access to care, CC4C attempts to bridge services and build trust among professionals and families. As its impact and reputation build, the model is being adopted more widely, with 87 places now embedding paediatric expertise into community and primary care.

Key learnings

• The model promotes trust, mutual learning and shared decision-making among GPs, paediatricians and other MDT representatives (such as health visitors, community nurses​, school nurse​s, social workers, wellbeing practitioners​, mental health practitioners, family hubs and social prescribers) to improve care coordination and quality of care.
• Hubs manage the health of defined populations (15,000 to 50,000), bringing together 4 to 5 GP practices. This approach ensures personalised care for complex cases and reduces unnecessary hospital referrals. Evidence shows that the model helps reach more children, young people and their families and carers from the most deprived quintile and improves equity of access to health and care compared to usual care.
• Specialist outreach equips GPs with skills to manage cases traditionally referred to hospitals, bridging knowledge gaps and fostering professional development.
• Education initiatives and practice champions empower people, enhance self-management and reduce reliance on specialist care.
• Social capital – defined as trust, reciprocity and improving clinical knowledge – lies at the heart of these strong working relationships and is a key driver of success. The professionals involved value the collaborative relationships and approach to care, reporting enhanced learning, improved ability to navigate the local healthcare system and developing system-wide networks to achieve common goals.

Impact

Comparing the 12 months before and after implementation in 2014 and 2015, CC4C reports:

• 39% decrease in new patient hospital appointments
• a further 42% of new patient appointments shifted from hospital to GP
• 19% reduction in subspecialty new appointments
• 17% drop in paediatric hospital admissions
• 22% fewer A&E attendances

CC4C data from August 2019 to February 2020 shows the model is still effective in diverting activity away from specialist acute referrals. For example, 72% of people referred to the CC4C service, who otherwise would have required specialist hospital referral, were instead reported to be managed through the hub clinic or MDT.

The experience of people and their carers has also improved, for example:

• Additionally, from a sample of 60 people:
  • 100% would recommend the service to friends and family
  • 88% felt involved in decisions
  • 88% reported increased confidence in their GP
  • 96% felt that their concerns were addressed and had received clear expectations

Publication reference: PRN01756_ii