Primary Care Standards Managing Asthma in Children & Young People

The Greater Manchester, Lancashire and South Cumbria Strategic Clinical Network (SCN) was established to promote effective collaboration across traditional and organisational boundaries to facilitate and enable health professions to work in partnership with the public, patients and carers to ensure the best use of resources, facilities, knowledge and experience.

Following extensive consultation with our stakeholders the Children & Young People's (CYP) Asthma Special Interest Group was established focused on improving outcomes for children and young people with asthma. Under the clinical leadership of Dr Kathryn Bibby, GP with Special Interest in Paediatrics, the group has drawn together a suite of minimum standards aimed at reducing variation in care and improving outcomes across all aspects of asthma care (0-19yrs) in primary, secondary and community care. This document draws together national best evidence and clinical consensus to set the minimum standards for care delivered to children and young people with asthma in Primary Care. Primary Care Standards Managing Asthma in Children & Young People
Asthma Report JC

N.B. All specialised services are additionally commissioned against the appropriate national specialised service specification. Severe asthma is currently commissioned as part of specialised paediatric services. These standards are an adjunct to the requirement of the service specifications.

As outlined by Public Health England, Child Health Profiles, admissions due to Asthma for children and young people (0-19 years) remains significantly higher than the England average across most of Greater Manchester & Lancashire. Only Cumbria falls in line with the national average.

A plethora of evidence suggests that up to 90% of all asthma admissions are preventable through better management in primary care.

Over a million children in the UK are currently receiving treatment for asthma. Many children with asthma have poor control of their condition, often as a consequence of poor compliance with therapy. This may lead to exacerbations of the condition and hospital admissions.

The aim of asthma care is to control symptoms and enable people to lead a normal life. Emergency admissions indicate a loss of control of the condition, and many of these could be avoided through early identification and effective and proactive management of the condition. The goal of treatment is for patients to be free of symptoms, and able to lead a normal, active life.

Currently despite a wealth of national reports and guidance emergency admissions for children and young people across our network are still above the national average and children across the country are still dying due to a lack of basic management of their asthma. This document is not designed to be another set of guidelines instead it supports the implementation of current best evidence by bringing together the key principles into one useable document focused on driving up standards for children and young people with asthma across Greater Manchester, Lancashire and South Cumbria.

It is projected that utilisation of these standards across Primary Care will improve outcomes for these children and young people and begin to reduce variation in care and emergency hospital admissions.

*In this document the term children or child should be taken as meaning children and young people from 0 to 19 years. Although, as outlined by the British Thoracic Society (BTS) it can be difficult to confirm a diagnosis of asthma in preschool children (under the age of 5 years), the standards set in this document should be viewed as best practice for all children. This is regardless of whether children have a confirmed diagnosis of asthma, or those children under 5 years, with a probability of asthma (low, med or high) (BTS) who are currently being monitored and receiving treatment from the GP Practice.

The BTS guideline provides clear guidance around the monitoring and treatment of children under 5 years based on the potential probability of an asthma diagnosis. Guidance is also available for the other respiratory conditions common in this age group. e.g. SIGN 91: Bronchiolitis in children.

Ensuring that health professionals have the right knowledge and skills to effectively diagnose and manage children with asthma will also promote the correct diagnosis and management of children with other childhood respiratory conditions.

This document is designed for commissioners and providers of asthma services for children and young people. It sets out the aspirations of stakeholders around the quality of children's asthma care across Greater Manchester, Lancashire & South Cumbria, alongside the British Guideline on the Management of Asthma and NICE quality standards to enable the effective commissioning of services which meet these minimum standards.

Providers will be able to use these standards as a self-assessment of their ability to deliver the required quality of acute care for children with asthma. They can be used to validate, challenge and to quality assure services. It is also suggested that CCGs sign the Asthma UK pledge to implement the NICE quality standards within the next 3 years.

Quality Improvement Service Provision for Children in the Community (CCNT)

Quality Improvement Service Provision for Children in the Community (CCNT)


What was the issue

Improving the experiences of children, young people and their families, care needs to be delivered across integrated pathways of services: primary, secondary and in some cases tertiary care; transition into adult services; and health, children's social care, education and housing services. Young people with long-term conditions are increasingly surviving into adulthood. Consideration must be given to the expertise required to provide care for these young people across all settings. The transition to adult services has been identified as a period of time when young people can be lost from health care, due to the failure of transition arrangements. Community children's nurses play a pivotal role in an individual's transition from children's services to adult services.

What we did

The purpose of a Community Children Nursing Team (CCNT) review was to evaluate existing services across the Greater Manchester, Lancashire and South Cumbria Strategic Clinical Networks (GMLSC SCNs) geographical footprint against national guidance and current best practice.

How we made a difference

The findings have resulted in this Quality Improvement Strategy with recommendations for the future provision of Community Nursing Services.

The overarching aim was the production and development of a Quality Improvement Strategy in pursuit of identifying and sharing good practice in CCN teams. The strategy illustrates how children's community nurses are a major component of out of hospital services.

There are 23 recommendations in the Quality Improvement Strategy all of which will greatly enhance existing CCN services and reduce the unwarranted variation in service standard across the SCN. Read copy of the full CCNT Report.

CYP A&E and Short Stay Paediatric Assessment Units (SSPA) department peer review

CYP A&E and Short Stay Paediatric Assessment Units (SSPA) department peer review

What was the issue

Our first priority must be the delivery of value-based care that puts young people and the family at the heart of what we are doing. We are there to offer patient-centered care and to offer young people the best integrated care pathway whatever the nature and degree of their difficulties are at any one point in time. Pathways for urgent and unscheduled care are often complex. During 2013/2014 there were a total of 309,582 CYP attendees at emergency departments in the GMLSC SCN footprint which equates around 30% of CYP population.

What we did

The Greater Manchester, Lancashire and South Cumbria SCN (GMLSC SCN) completed a peer review of service provision in emergency care settings across the footprint throughout the summer of 2014. A total of 16 emergency care service team visits took place for the review.
The purpose of the peer review was to benchmark each of the emergency care services against the Royal College of Paediatrics and Child Health Standards for Children and Young people in emergency care setting developed by the Intercollegiate Committee for Standards for Children, Young People in Emergency Care settings 2012. There are 9 key standard topics with a subset of standards for each topic.

How we made a difference

The report demonstrated that there are many organisations that show excellent examples of good practice along with innovative ideas of managing and delivering services. The review does not examine patient outcomes, nor does it measure standards against perceived outcomes for children and their families using the services.

Ready, Steady, Go

Ready, Steady, Go

What was the issue?

Young people (YP) face plenty of challenges when preparing for adult life. For the 40,000 children and young people with complex physical health needs, there are many additional hurdles. In many cases, the health needs of these young people will have been met by the same people who have looked after them for as long as they can remember. However, one of the changes as they reach adulthood is the transfer to an adult environment where they may need to consult several different health teams, therapy teams, and adult social care services (Care Quality Commission (2014)). 

In April 2015 a key enabler, highlighted by a SCN Transition consultation event, was the need to provide clinicians with training in the use of tools that could be used to support young people and their families through the transition process.

What we did?

On the 22nd October 2015 we held the 'Time to Act – Ready, Steady Go Workshop' under the direction of Dr Christian DeGoede, SCN Transition Project Clinical Lead.

Ready Steady Go is a structured, but where necessary adaptable, transition programme for YP with a long-term condition aged 11+ years. A key principle throughout Ready Steady Go is 'empowering' the YP to take control of their lives, equipping them with the necessary skills and knowledge to manage their own healthcare confidently and successfully in both paediatric and adult services.

How we made a difference?

The event successfully achieved the following objectives:
• To train clinicians in the use of the Ready Steady Go Tool
• To provide an opportunity for clinicians to develop an action plan that supports the implementation of Ready Steady Go in their organisation or clinical area
• To provide an opportunity for networking and sharing of good practice around transition services

 View the Evaluation Report and Presentations from the October 2015 event in the CYP Training & Events section.