A Healthier Wales:The Primary Care Model for Wales

What does it mean for you?

Sue Morgan, National Director for Primary Care

Alan Lawrie, Director of Primary, Community & Mental Health, Cwm Taf HB

Primary Care Plan for Wales 2015-18.

Five priority areas for action:

• Planning care locally• Improving access & quality• Equitable access• A skilled local workforce• Strong leadership

Progress Against Primary Care PlanPlanning care locally- Pacesetter programme, 24 projects 2015-18- ‘Transformational’ primary care modelImproving access & quality- 111 roll-out, choose pharmacy & common ailmentsA skilled local workforce- New roles eg community paramedics, navigatorsEquitable access- Inverse care lawStrong leadership- P&C Care Hub, development programmes

DP&CC Annual Report 2017-18

Key Messages • Health and Social Care will work together…... joined up

and scaled up

• Get better at measuring what really matters to people

• Make Wales a great place to work in Health & Social Care

• Invest in new technologies

• Work as a single system, everyone working together

• Shift services out of hospitals into the community

• Implement the primary care model for Wales

Pacesetter Programme 2015 – 18 24 projects evaluated on ‘Once for Wales’ basis - outcomes

and learning shared across Wales Links and interdependencies between projects evolved from

front-line service redesign.....

MDT Primary Care Clusters are the way forward Safe & effective triage systems direct people to the right

professional in the team at the point of contact Integrated teams ensure a holistic approach to care - physical,

mental and social well-being Services must work well across in- and out-of-hours to ensure

seamless care Success also depends on an informed public who live healthily

& have access to a range of community services

Integrated, whole systems approach: Well Being of Future Gen Act

Stable Primary Care

New Cluster Models

Reduced preventable & avoidable

ED / hospital admissions

Range of new community

services

Improved access to

quality care

Complex & Specialised Care

in Community

IMPROVING ACCESS & QUALITY...

Releases GP & Adv Practitioner time and skills

Releases hospital

specialists Enhanced

MultiprofessionalPC Teams

Sustainable Models of Care

Stable Primary Care

New Cluster Models

Motivated professionals

Reduced preventable &

avoidable ED/hospital admissions

Integrated, Whole Systems Approach

Complex & Specialised Care

in Community

Sustainable Community Resources

Increased citizen

wellbeing

Promotion of Healthy Living

Accessible Resources

Wide Range of CommunityResources

Support for Self Care

Increased Community Resilience

Informed Public

Empowered Citizens

Improved access to

quality care

ALL WALES WHOLE SYSTEM APPROACH

What next for Primary Care….

• Reinforces our direction of travel

• Looking for pace & scale

“Strategic Programme for Primary Care”

Not a ‘new’ plan…continuation of the journey

Primary Care Model for Wales

Three strategic areas to progress

I. Primary Care Specific Workstreams• Prevention and wellbeing• 24/7 Model• Digital Technology• Workforce & Organisational Development• Communication, Engagement & Co-production• Transformation Programme & the Vision for Clusters

II. Integration• Health Board• Wider Stakeholders

III. Primary Care Contractors• GMS, Pharmacy, Optometry, Dental

How Does That Work Locally ? CWM TAF UHB [ CTUHB ]

Background

• Serves population of circa 300k• Covers two Local Authorities

RCT & Merthyr • Annual Budget £620m of which £276m

(45%) in Primary and Community Care • 8 formal clusters acting as 4 localities• Seen as well performing organisation• Good working arrangement at RPB• About to grow by 140,000 ( Bridgend)

Where are our Clusters Current Position

• Moving from GP driven to Primary Care focussed over 18 months

• Real focus upon Sustainability over 18 months• Have used funding innovatively on MDT working, advanced

training practices, mental health at primary care level, GP Support Officers

• Cluster leadership very much GP / Practice dominated • Supported by Full Time Development Managers • Seat for others at cluster meetings – but mixed attendance

DOES THAT FEEL LIKE YOUR CLUSTER TOO ??

Where are our Clusters What was their view on Transformation • Without a proper plan – the future will become increasingly

challenging

• Cluster ownership of plan – not a dictated proposition

• A focus of delivering an enhanced MDT model (called different things)

• Partial acceptance of planned / urgent split

• Need for local approach with pan Cwm Taf Outcomes

• A plan that is inclusive and equitable

• Recognition of National Reviews – Playing the WG game

Where do we aspire to ?

• Virtual Ward in North Cynon – excellent MDT with Social worker , OT, Pharmacist , Paramedic , enthusiastic GP –focussed on top 3%

• Potential for wider adoption / ADAPTION in all clustersEXTENDED COMMUNITY RESOURCE TEAMS

• Excellent other examples; GP Support Officers. MIND , Community Transport ….. Best use of Cluster Funding

• Clear linkages with community assets• Cwm Taf GPs & Community Service well engaged with

local communities

WHERE IS YOUR CLUSTER ON THIS AGENDA ?

THE EXTENDED COMMUNITY RESOURCE TEAM• GP Staff i.e. GP's, practice nurses • Clinical Pharmacists• OT, Physio, Podiatry, SLT, Dietetics• Community Paramedics• Advanced Care Planning Nurses and palliative care inputs• District Nurses (Neighbourhood Nursing Teams based on Buurtzorg model)• Health Visitors• @Home and Stay Well @Home staff• Physicians assistants• Chronic Disease Specialist Nurses based in community and reach into acute care• Social Workers and Homecare Staff• Care of the Elderly medical inputs• Welsh Ambulance Service or alternative provider• Secondary care / specialists for advice and support• Diagnostic Staff with localised access• Third Sector workers especially community co-ordinators/social prescribing• Community midwives• Inputs from paediatric community consultants and CAMHS • Management and administration support

WHAT DO WE EXPECT THE OUTCOMES TO BE ?

• Substantial Improvement in SUSTAINABILITY • Improved access to primary care services• Increase in the number of people with an anticipatory

care plan • A reduction in acute outpatient appointments • A reduction in medicines management costs• A reduction in the demand for out of hours services

• A reduction in hospital conveyances by ambulance and admissions with a reduced length of stay when someone needs acute care

• Shift of interventions from clinical environments to an individual’s home environment

• Improvement in patient safety • Improved infrastructure and utilisation of IT and AI across Health

and Social Care• Increased Advanced Care Plans within individual homes of

residence• Reduced waiting times to diagnostic and increased access to Point

of Care Testing (POCT)

WHAT DO WE EXPECT THE OUTCOMES TO BE ?

Where do we aspire to …. (2)

• Buy into Transformation Proposals ( Needs Google Translate)

• Freedom to develop , support , clarity of purpose• Leading System Management • Maximising autonomy over time • Bedrock of service delivery

WHERE WOULD YOU WANT YOUR CLUSTER BE?DOES YOUR HEALTH BOARD AGREE ?

CTUHB Working with OthersThe RPB Dynamic

• Well developed relationships with RPB• ICF, Capital , MH bids , Dementia Plan all

partnership ( SW@H 1 big triumph)• Transformation Plan signed off – SW@H2 , Major

Anticipatory Care focus , population segmentation and good political support !

• Sharing of the pain • Looking to learn from Bridgend on Integration

Transformation – the futureTransformation = change ….. the most cost effective way of

improving health and well-being is no longer the traditional GP model

• Integrated whole system approach

• Different relationship between public and health professionals

• Working at cluster level

• Social prescribing & community referral

• Multi-professional approach

• Multi-organisational approach

WORKING TOGETHER TO CREATE A SUSTAINABLE HEALTH SERVICE

Transformation – the challenges for you• Working with partners to deliver outcomes requires

sophisticated set of skills particularly when there are competing priorities/targets

• New roles – GP practice, cluster level and with partners

• Maximising the opportunities of wider community assets

• Leadership in a dispersed model – clinical and non-clinical

• New service model = new business model

Discussion• How can PMs most effectively work with HBs and

DPCC on the Strategic Programme for Primary Care?

• What Leadership development would work best and how best to arrange for PMs?

• What might Regional Networks look like for PMs and is that a good way of working?

• Anything else you want to share with us?