General practice and the transition from paediatric to adult health services

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A poor healthcare transition can lead to potentially serious health-related consequences for the individual concerned (Bhawra et al 2016). Many reports including ‘From the pond into the sea’ (CQC 2014) and ‘Transition from children’s to adults’ services’ (NICE 2023) contain guidance on improving the process, including closer engagement between secondary care and general practice. However, there remains little evidence on how general practice can successfully support young people as they transition from paediatric to adult services. University Hospital of Derby and Burton (UHDB) have a dedicated healthcare transition team. In 2023 NHS England funded a fellowship hosted by Derbyshire Community Healthcare NHS Foundation Trust to look in greater detail at primary care and the transition from paediatric to adult services of young people with complex medical. An audit of healthcare transition in general practice and a process mapping exercise were completed. Numerous stakeholders were consulted, ranging from young people who had gone through transition to the LMC. In agreement with the ICB, the following proposals were accepted: Use of SNOMED code 931881000000106 “in transition from childrens to adult care services. General practice were not aware a young person was going through transition. Secondary care to request the SNOMED code to be added to the young person’s clinical record until 25-years-old. Refer patients with extra vulnerabilities to general practice care coordinators. Care coordinators are pivotal within primary care as the interface between multiple parties. Asking secondary care to refer directly is an opportunity to streamline the process....