Community paediatricians

Assessments will vary 

As part of the assessment the community paediatrician may:

• Give specialist advice on specific problems and arrange medical tests if needed
• Work closely with many other health professionals to ensure a child receives all the help they need – those professionals might include health visitors, school nurses, GPs, physiotherapists, speech and language therapists, clinical psychologists, child and adolescent mental health services (CAMHS) professionals and hospital-based specialists
• Work closely with, and give medical advice to, professionals in education and social care
• Give medical advice to the education authority when a child’s special educational needs (SEN) are being assessed
• Help manage the medical needs of children who are being adopted or are in foster care (looked after by the local authority).

Generally the first appointment lasts up to one hour; later review appointments are usually shorter, at around 30 minutes.

After the first assessment

The community paediatrician will usually send a letter about what was discussed and what actions were decided should be taken.

A copy of that letter will also be sent to the family’s GP. Sometimes we also write to other professionals who are involved in a child’s care such as a child’s Speech and Language Therapist, provided the child’s parents or carers agree for us to do this.

Referrals are accepted from:

• GPs
• Health visitors, school nurses and specialist nurses
• Paediatric therapists
• Other medical consultants (e.g. CAMHS consultants, hospital-based paediatricians)
• Social care services
• Local education authorities
• Police.

Key points

Please note the following:

• Children must registered with a GP practice in Derby city, Amber Valley, Erewash, or South Derbyshire and South Dales.
• We accept children aged 0-16 years (up to 19 years if in special school placement).
• All relevant forms must be completed as incomplete referral templates will be returned to the referrer for more information. Please complete the new referral forms, by downloading the referral form each time from the website. Older versions of referral forms will not be accepted and will be returned to the referrer. Please see referral criteria and referral forms on this page.
• All referrals should include clearly the reason for the referral and with a clear referral question.

• The referral form and questionnaires should be sent to SPOA.

• For referrals for developmental problems in under 4s - please complete the under 4 referral form.

• For referrals into the ASD or ADHD assessment pathway with concerns causing significant impairment, please complete the pre-school or school-age concern form (depending on the age of the child), the parent/carer questionnaire and the neurodevelopmental referral form. Please note we do not accept referrals for ADHD assessment for children under 5 and a half years of age.

• A diagnosis is not needed to access support. Support via the graduated response is needs led and not diagnosis dependent.

• For adult neurodevelopmental assessments, please refer to the adult Neurodevelopmental service.

Acceptance criteria

We accept referrals for diagnostic assessment, opinion and advice on management of the following:

Developmental problems

Referral criteria:

• Complex developmental impairment in preschool children (under four years old) following assessment by either health visitor, nursery nurse, speech and language therapist, or other paediatrician and with appropriate information.

Criteria for acceptance by the Ronnie Mackeith Centre for assessment:

Any child who has:

• Lost developmental skills (developmental regression) at any age (urgent referral)
• Any child under the age of 1 year old with moderate to severe global developmental impairment
• Any child under the age of 4 years old with severe or profound global developmental impairment
• Any child under the age of 4 years old with isolated gross motor impairment. E.g. unable to sit unsupported by age 12 months or unable to walk by 18 months (boys) or 2 years (girls)
• Suspected clinical diagnosis of cerebral palsy where confirmation of diagnosis or second opinion on diagnosis is required
• A new diagnosis of cerebral palsy (as a one-off review if GMFCS level 1 or 2)
• A diagnosis of cerebral palsy classified as GMFCS levels 3 to 5 (for ongoing follow up)
• Cerebral palsy where further advice regarding tone management is required
• Cerebral palsy where there are concerns about hip subluxation as per ‘Cerebral Palsy Clinical Guideline’ ie migration percentage on hip x-ray of >30%
• Complex disabilities at any age which require a multidisciplinary package of care
• A known/ likely neuromuscular condition
• Down Syndrome.

Neurodevelopmental assessment

Neurodevelopmental assessment for possible autism spectrum disorder or attention deficit hyperactivity disorder causing significant impairment. Please complete the Neurodevelopmental referral form along with the parent/carer questionnaire and teacher questionnaire (school or preschool questionnaire).

Please note we do not accept referrals for ADHD assessment for children under 51/2 years of age. For pre-school children, a referral to the speech and language therapy service should be considered at the same time.

A diagnosis is not needed to access support. Support is needs led via the local offer graduated response and not diagnosis led.

Neurodisability

Children with complex physical and intellectual disability, medical assessment of children with sensory impairment and palliative care for children.

Complex severe learning disability

This requires supporting evidence from an educational psychologist first before referral. It is only for a medical assessment where there is concern about a medical co-morbidity.

Down syndrome

Down syndrome under the age of 14.

Children with coordination problems

Children with coordination problems as a sole problem will only be accepted after the child has received input from the physical literacy programme within schools wherever this is available (associated learning problems are managed by education). If the problem still persists, self-referrals can be made directly to the Therapy service where the child can be seen by a physiotherapist and/or occupational therapist as deemed appropriate. Paediatrician input may be sought too to rule out an underlying neurological or neuromuscular disorder if the referrer feels unable to rule these out. Both referrals can be done at the same time.

Educational

Referral criteria: statutory - medical advice for education health care plan.

Social care services

Referral criteria:

• Child protection (referrals should come from social care services).
• Statutory looked after children/adoption work.

We are unable to accept referrals for the following:

• Concerns about hearing, which should be referred directly to the audiology clinic
• Concerns about growth as a sole problem, which should be referred to hospital if paediatric input is required
• Enuresis and constipation/soiling, which is managed in school health teams with advice from the children’s continence service if needed, and referral if necessary, in addition to GP and/or hospital medical support
• Concerns about epilepsy which should be referred to the hospital paediatrician
• General behavioural issues, emotional difficulties, mild mental health issues. Locally, the service that is commissioned to work with children who are suffering with mild mental health, emotional or behavioural difficulties is Compass
• For more significant concerns about a child suffering mental health difficulties, we would recommend referral to CAMHS Children's mental health services
• Emerging or low-level needs may be met by universal services or other appropriate services. Agencies that identify emerging needs of a child and their family should complete an early help assessment referral
• For problems with educational provision or attainment, these would be better addressed by schools (through the Special Educational Needs Coordinator, SENCO). Independent advice can also be sought from Derbyshire Information and Advice Service for SEND
• Dyslexia assessments are not undertaken by the Neurodevelopmental pathway or the Community Paediatric service. Such concerns should be discussed with the school. We recommend that learning difficulties in school age children, are evaluated by the school special education needs coordinator (SENCO) and/or educational psychologist
• Referrals for sleep concerns without an underlying neurodevelopmental disorder

• Referrals for sleep concerns in children with an underlying neurodevelopmental disorder will not be accepted without evidence of accessing sleep advice and support first and accompanied by a sleep diary. We would recommend accessing and following through with sleep advice prior to referral if the problem persists. Sleep advice and support can be obtained from:
  - The neurodevelopmental hubs
  - The Children's Sleep Charity
  - Cerebra 
  - Health visitors can provide advice and support on sleep.

Before making a referral

Before making a referral, early concerns about social communication and interaction can be monitored and supported through early intervention services before formal autism assessment. These include:

• Speech and Language Therapy
• Health Visitor support
• Early Years setting support
• Children's Centre services
• Portage.

Referrals are made through the Single Point of Access (SPOA) for specialist children’s services in Derby and southern Derbyshire. Please note – we cover Derby city and the south of the county.

To make a referral, please download and complete the form below. Please supply as much information as possible. This will ensure that the assessment is carried out by the most appropriate professional(s). Referrals will not be processed without the completed form.

Community Paediatrics - referrals up to the 4th birthday

Returning the completed form

The completed form can be submitted by...

Email: dhcft.SPOA@nhs.net

Post: Single Point of Access, Temple House, Mill Hill Lane, Derby DE23 6SA.

If you need to discuss a new or existing referral, the SPOA Administrator can be contacted on 0300 7900 264.

• We are happy to discuss referrals if you are unsure as to the suitability of any referral for our service
• Providing plenty of information can help a timely assessment. Please enclose all relevant reports that are available, e.g. speech and language therapy, previous paediatric assessments, educational reports, social work assessments, common assessment framework (CAF) forms. All children referred should have results of recent hearing and vision tests
• Referrals onto the neurodevelopmental pathway are assessed by a multi-agency team as part of the Children's Services Single Point of Access (SPOA). Learn more by viewing our neurodevelopmental pathway leaflet and our jourey plan. There is also a glossary explaining the agencies and teams involved in the pathway.