Developing an Enhanced Infant Feeding service offering Frenotomy in Local Community Within Family Hub: Leicester City Council

The proposal to introduce a frenotomy service for families in Leicester emerged as an enhanced requirement within the Family Hub Programme. Through collaborative partnership working and the development of trusted relationships, the aim was to deliver continuity and equity of care for families while meeting programme objectives.

Initially, funding focused on raising awareness and training staff to identify tongue-ties causing feeding difficulties. However, concerns were raised that this approach could increase demand on existing arrangements, which were already insufficient and lacked a holistic service model. This risked parent’s seeking private treatment and potentially ending their breastfeeding journey prematurely.

The enhanced service integrates assessment, division, and feeding support in a single location, delivered promptly within the family’s local community. Evidence demonstrates that health outcomes are poorer in some communities due to societal inequalities, and breastfeeding is proven to help reduce these disparities. Leicester City ranks as the 32nd most deprived local authority in England (English Indices of Deprivation, Data.GOV.UK, 2019).

Certain groups face barriers in accessing services, receiving care, and feeling heard. The introduction of the frenotomy service specifically aims to improve access and outcomes for vulnerable populations, addressing these gaps. This initiative has been developed collaboratively with Leicester City Council Family Hubs Programme, Leicestershire Partnership NHS Trust, and the Integrated Care Board.

The Enhanced Infant Feeding Service seeks to deliver measurable benefits for:

• Infant health – improved nutrition and reduced complications.
• Parental wellbeing – enhanced physical and mental health.
• Healthcare system efficiency – reduced demand on NHS resources, as recognised in The Lancet Series (2016).
• Alignment with the Darzi Integrated Care Model.
• Enable robust data collection, audits, and outcome evaluation for long-term impact.

• Holistic, one-stop approach: Combining assessment, treatment, and feeding support to streamline care, reduce fragmentation, and minimise delays.
• Efficient use of Public Health Teams’ time and improved productivity.
• Release of Paediatric and ENT consultant time, increasing capacity.
• Improved resource allocation across services.
• Collaboration with Best Start for Life Family Hubs to raise awareness and promote services within cluster areas.

1. Digitalisation
   • Integration of electronic health records linked to GP systems.
   • Digital resources via Health for Under 5s and innovative tools such as the Communication Annexe for sharing resources with parents.
2. Community-Centred Care
   • Transition from hospital-based to community-based care, reducing pressure on hospitals (currently two consultant-led clinics per month) and delivering care closer to home.
3. Prevention over Treatment
   • Proactive breastfeeding support and timely intervention to prevent illness, improve population health, and reduce demand on acute services.

Service Development and Evidence Base

The frenotomy service has been established through a collaborative approach involving Leicester City Council Family Hubs Programme, Leicestershire Partnership NHS Trust (LPT), and members of the Integrated Care Board (ICB). This partnership model ensures alignment with local priorities and supports integrated care delivery within the community.

The LPT Infant Feeding Team has enhanced its existing service by introducing a dedicated Frenotomy Clinic, alongside oral assessments and breastfeeding support. This integrated model provides a holistic and comprehensive service, reducing reliance on hospital-based or out-of-area referrals and improving timely access for infants experiencing feeding difficulties.

Clinical evidence strongly supports the role of frenotomy in improving breastfeeding outcomes for infants with tongue-tie:

• NICE Guidance (2005) and Bruney et al. (2022) confirm that frenotomy offers significant benefits compared to intensive lactation support alone.
• While the procedure demonstrates marked improvements in feeding outcomes, it remains essential that healthcare professionals undertake individualised assessments to ensure the intervention is appropriate and beneficial for both infant and mother.

This evidence-based approach underpins the service design, ensuring that care is safe, effective, and responsive to family needs.

Once the working group agreed to the development of the service, the proposal was taken through Leicestershire Partnership Trust governance process and a meeting was held with legal department who identified that the local authority could not commission what is considered to be a surgical procedure. This was when the ICB were contacted about supporting the service. Support was gained from the Children and Young people’s partnership, who worked to gain support from Leicester’s Local Maternity and Neonatal Service and University Hospitals of Leicester. 

The ICB felt strongly that this would not be an equitable service if it was only offered to Leicester, therefore funding was sought from the ICB to offer the service across Leicester, Leicestershire & Rutland (LLR). Funds were identified for the procedure paid to other areas. The ICB finance group supported the service as a cost neutral service and agreed to reallocate these funds on top of the Family Hubs funds to provide an LLR service. After finalising a standard operating guideline, completing a Quality Impact Assessment, and notifying the CQC, the service was ready to launch. 

The service launched in July, and impact has been immediate. Families are seen in the community within one week of referral, in comparison to previously waiting 8-12 weeks. The early data shows immediate improvement in feeding efficiency, continued improvement in feeding efficiency, improvement in maternal pain, improved weight gain, continuation of breast feeding, transitioning from bottle or combined feeding to exclusive breast feeding. 

One mother summed it up beautifully:

 That’s the best feed he’s ever had. He’s never looked this relaxed after a feed.” 

 

Another told us, 

“He’s normally so unsettled when feeding. Today he was calm for the first time.” 

The service offers a weekly clinic where Infant Feeding Specialists are supported by an Infant Feeding Practitioner, who provides post frenotomy feeding support and advice. Follow-up calls are made once a week after the clinic to review progress and assess further support required. A Friends and Family Questionnaire is sent out post procedure and at the end of care; to collate feedback and then a follow-up questionnaire is sent to families 3-months post procedure. 

The service is something we in Leicester are very proud of with the whole process taking over 18 months with many challenges along the way. We continued with tenacity, as we knew the difference this would make to families in Leicester City. What was initially thought to be a six-month project became an 18-month journey through layered governance, legal considerations, and multi-agency negotiation. The team learned the importance of realistic timelines, staying resilient, and investing early in practitioner training to build a stronger clinical workforce. One key learning point has been the importance of having key people championing the service, someone who understood the system and could advocate for the service when it mattered most. We had a key paediatrician, and ICB member who were invaluable, who knew the value of the service and could fight our corner.

The service reflects the values that inspired it: equity, compassion, and community-based care. It has reduced pressure on paediatric and ENT consultants, aligned with NHS transformation priorities, and created a seamless pathway for families who might otherwise have fallen through gaps in provision. Ongoing evaluation at one week and three months post-procedure will help secure long-term sustainability beyond 2027. This service will change infant feeding journeys, improve breastfeeding continuation, improve mother and baby health, reduce pressure on acute services and save the NHS money. 

Advice to others includes to capture the service users’ voice as this is so impactful. The evidence base is out there on the benefits of breast feeding and the impact a tongue tie can have on this. One area that would need closer analysis is the workforce model, increasing the number of practitioners trained to complete procedure. In hindsight setting lower expectations regarding the launch date is key. We thought this could be achieved in 6months, but this was not a realistic goal. 

The service has been launched since July. Families are now seen within one week of referral. Early data shows there has been an improvement in infant feeding experience. Mothers report that they are still breastfeeding, where they would have stopped if they had not had the procedure. 

Here are examples of feedback received following procedure:

‘We were met by two friendly professionals who walked us through the tongue tie procedure, my husband and I felt confident about the much-needed procedure with the team. I was pleased to see two females and thankful for the additional support with breastfeeding as the main reason we were going ahead with the procedure was to improve breastfeeding.’

‘The staff were both amazing. we, me & my husband were very nervous about the procedure on our 2month old baby on tongue tie release, but they made us so comfortable and pleasant experience we ever had... our baby was very happy and smiling and calm as well. Thank you so much for such a wonderful experience.’

 

This case study stands as a testament to what can be achieved when partners share a vision and refuse to let obstacles halt progress. It highlights not just a new service, but a new way of working—one where families receive timely, holistic care close to home, and where the voices of parents help shape the system that supports them.

Rowena Sercombe (Infant Feeding Lead for Family Hubs) and Claire Hubbard (Infant Feeding Clinical Lead Leicester Partnership Trust) 

Leicester City Council