How can we reduce the backlog and wait times to see a paediatrician?

There are 5,944 children on waitlists to see a paediatrician in Perth.

Parents are at their wits’ end as they struggle to get specialists to see their children.

Paediatricians are burnt out. Dr Andrew Savery has already flagged his intention to retire in June 2023.  Dr David Roberts will retire in January 2025. I suspect that there will be more that follow.

The Western Australian Parliamentary inquiry into access to child development services is one step, but unfortunately these things take so long.

I asked Perth’s paediatric practices what they thought might help fast track the bottleneck in access to child development services in Western Australia.

THE MAIN ISSUE WITH ADHD REFERRALS ... IS THE ONGOING MEDICINAL MANAGEMENT WHICH MUST BE COMPLETED BY PAEDIATRICIANS DUE TO REGULATIONS ON STIMULANT MEDICATIONS. THIS TAKES ALL OF OUR PAEDIATRICIAN AND ADMIN TIME AWAY FROM SEEING NEW PATIENTS.

Q: What is the single most impactful thing we could do to reduce the backlong and wait times?

“To have people turn up for their appointments, or cancel them if not required. Don’t just not turn up.” – Perth paediatric practice manager

Q: If you were in charge, what would you do?

“Can only be on one list not 10. This has created a bottleneck in itself! To get a script, must have an
appointment. The requests for scripts outside of appointments is incredible.

“GPs won’t do scripts without an appointment, why do the families expect a specialist to do them? For no cost and immediately. So much pressure for everyone.

We try to educate people regarding script expiry and dispensing dates. Parents need to be a bit more organised in this area.” – Perth paediatric practice manager

Q: Is there anything that is not being included on referrals that should be, or that would make the process of reviewing and triaging referrals any easier for you?

“Often [referrals are] very brief as GPs are time poor. We ask for further information once referral is triaged. 

Basic information such as family structure, if family court involvement a copy of the orders, previous developmental milestones and past medical history, previous interventions and response, any supplements or medications, any school supports in place and if the referring GP is willing to be a co-prescriber.” – Perth paediatrician.

we often decline one-line referrals. the more information that is given on initial referral, the better.

 

“GP referrals to specifically mention indicating behaviours and suggest what is to be assessed for e.g. ADHD or ASD.  A referral which says “developmental review” doesn’t give us any information to go on.” – Perth paediatric practice

“We often decline one line referrals. The more information that is given on initial referral, the better.  ADHD and ASD are two separate assessments and generally cannot be done together. We have to ask parents which one they would prefer completed first. Again, GPs are time poor and put on same referral.” – Perth paediatric practice manager

“We are telling parents to email us a GP referral, one recent school report and asking parents to also summarise the issues they are having with their child.  Doctors will assess the reports etc and then we will contact the parents for an appointment.”  – Perth paediatric practice manager

Q: Would a standardised referral template help?

The national guideline for the assessment and diagnosis includes a standardised referral template.

“That would be helpful.” – Perth paediatrician 

“Absolutely!” – Perth paediatric practice manager

Q: Are there any common situations where patients are being referred to developmental paediatricians who could be referred elsewhere?

“General paediatricians can assess and managed ADHD if they have the training and are willing to do so. Child psychiatrists also work in this space.” – Perth paediatrician

“This may help, but the main issue with ADHD referrals at the moment is the ongoing medicinal management which must be completed by the Paediatricians due to regulations on stimulant medications.  This takes all of our Paediatrician and Admin time away from seeing new patients.” – Perth paediatric practice manager

Q: Would it help that all referrals for suspected ADHD are responded to and the following provided to parents for sending / completing before the referral is triaged?

For example, a completed parent and school Conners rating scale, educational psychology report if available, outline of response to intervention and other reports/questionnaires?

“Different clinicians use different assessments based on their preference and the age of the child, so no. These are sent out to the families and requested to complete it before

their appointment with the paed.” – Perth paediatrician

“It’s also not ideal to have a clin psych diagnose ADHD then tell parents to just get a paed to do meds. They won’t do this! All paeds will do their own assessment. They will take on

information from other disciplines, but not just on their say so.” Perth paediatric practice manager

“This is additional information for our assessment, we will still have to spend the same amount of time reviewing those reports and collecting our own observations of the child’s behaviour to make a diagnosis.” – Perth paediatric practice manager

Q: Would you prefer families who suspect ADHD have completed a psycho-educational assessment prior to their first appointment with you?

This is an unnecessary expense for the family unless indicated. 

I refer for one if the diagnosis isn’t clear or I suspect a specific learning disorder.” – Perth paediatrician

Q: What would you recommend to families who are waiting to access a paediatrician?

“Intervention with an OT or psychologist, join ADHD WA and learn about the condition, medications etc.” – Perth paediatrician

“We can provide a letter to confirm that they are on our waitlist and this will allow them to access support at school in the meantime.  

It would also be very beneficial for these children to be linked up with other therapy services in the interim, to start building other coping mechanisms and support with daily activities.” – Perth paediatric practice manager

Q: Are there any models you are aware of that would help?

Would a stepped care approach as used at Royal Children’s Hospital in Melbourne help?  ADHD nurse triaging as used in the UK?  A lean review as undertaken by the NHS that made rapid improvements in waiting times and the waiting list backlog?  Other models that you’re aware of in Australia or overseas that may help here?

No responses to the question yet!

What do you think would fix our current situation?

Post your ideas in the comments or email Pia at hello@perthkidshub.com.au