IHSC SIG 23.10.15
Attachment 3: Primary Care Developments
WELSH GOVERNMENT PRIMARY CARE INVESTMENT UPDATE – OCTOBER 2015
1. INTRODUCTION
The Welsh Government Primary Care investment helps to deliver the key priorities as set out in the ‘Primary Care Plan for Wales up to 2018’, and the
areas for action within the ‘Planned Primary Care Workforce Plan for Wales’. It should be noted that although the funding is badged as Primary Care
investment, the Primary Care Plan and the Planned Primary Care Workforce Plan for Wales are very much focused on “out of hospital care” in its
widest sense, and the investment and schemes developed reflect this through strengthening the primary and community services infrastructure. For
Cardiff and Vale circa £5m was made available to improve out of hospital care through the Primary Care investment in 2015/16, which is recurrent
funding based on outcomes and delivery. This briefing provides an update on this investment.
2. PRIMARY CARE DEVELOPMENT INVESTMENT
Cardiff and Vale UHB received a proportional share of £3.321 million (of the £23.07m national investment) to fund the schemes as set out in the
Integrated Medium Term Plan (IMTP). The IMTP focused on expanding the community infrastructure to ensure there is resilience and sustainability.
This provides a solid foundation to redesign pathways and align service models in order to deliver more care in the community. This will support
services to the highest acuity patients in the community including housebound elderly frail and residents of care homes. A summary of the schemes
funded via the £3.321m Primary Care Development investment is set out below:
Scheme Name and Description, WG Allocation for 2015/16
1. Expansion of the Community Resource Team (CRT) model –
enhancing support to GPs in managing high acuity patients in the
Community/Care Homes and on discharge from hospital.
£1,435,000 WG allocation for 2015/16.
Progress
 Recruitment drive complete, including recruitment open day successfully
held with over 75 staff attending
 Age Connect appointments for Cardiff CRTs completed, contracts offered
and staff due to start October 2015
 Majority of therapy interviews completed, appointments being offered
 Consultation on extended hours launched and progressing to agreed
timescales
 Nursing Home - Local Enhanced Service (LES) out to GP practices for
expressions of interest, to-date 24 practices accredited and 4 pending.
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For more information on the WG Primary Care Investment in Cardiff and Vale, or to provide any
feedback please contact: Claire Watson on 02920 335395 or [email protected]
IHSC SIG 23.10.15
Attachment 3: Primary Care Developments
Scheme Name and Description, WG Allocation for 2015/16
Progress
2. Development of a dedicated phlebotomy service – to allow an
expanded Community Nursing Service to improve responsiveness to
Primary Care and Secondary Care.
£220,000 WG allocation for 2015/16.
3. Well-being Co-ordinators – improve the interface between GPs
and the community to deliver public health priorities and embed
public health principles and enhance the social model of care
through their use of community networks and experience of coproduction.
£183k WG allocation for 2015/16.
 Initial engagement with stakeholder to review the options available to deliver
a phlebotomy only service
 Community Directors (lead GPs) views and input collated on the options
available.
 Invitation to tender (ITT) out to tender
 Evaluation criteria developed for the new posts with significant input from
Public Health Wales
 Engagement with the Third Sector via the regional lead
 Clusters considering detailed work-plans for the WB Co-ordinators at a
Locality and Cluster level to be developed in partnership with the
organisation(s) which get the funding.
 Working Group composition agreed to include both secondary and primary
care colleagues
 Agreed professional reporting should be to Lead Nurse in secondary care
with day to day operational management to Lead Nurse in the Locality.
4. Embedding the Community Diabetes Model – through
developing a wider MDT model, based in the community with a
primary care Diabetic Specialist Nurse team approach via crosscluster working.
£90,000 WG allocation for 2015/16.
5. Delivery of additional local family planning and STI screening
services – at weekends and bank holidays, from two central
locations, one in Barry and the other in Cardiff City centre.
£46,000 WG allocation for 2015/16.
6. Establishment of a Permanent Optometric Advisor to Support the Continuance of Post Cataract Follow Up Appointments
in the Community and explore further opportunities at Cluster level.`
£14,000 WG allocation for 2015/16.
7. Delivery of Cluster based Pulmonary Rehabilitation
programme – the pulmonary rehabilitation programme will be
delivered locally within the cluster, ensuring more services are
shifted from hospital settings into the community.
£8,000 WG allocation for 2015/16.
 Options to deliver the new model presented to consultants and feedback
received
 Two Task & Finish Groups established to take forward IT and consolidation
and improvement of services.
 Optometric Advisor in post to drive improvement work and linked to GP
lead.
 Optometric Advisor to present at January Cardiff Protected Education Time
(CPET) and practice manager training regarding Wales Eye Care Service
(WECS) accredited optometrists.
 Suitable premises identified for the programme within the East Cardiff
Cluster
 Agreed to combine with Education programme and work with North Cardiff
Cluster.
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For more information on the WG Primary Care Investment in Cardiff and Vale, or to provide any
feedback please contact: Claire Watson on 02920 335395 or [email protected]
IHSC SIG 23.10.15
Attachment 3: Primary Care Developments
Pacesetter Investment
Welsh Government has allocated £4m across Wales to fund pathfinder or pacesetting projects for primary care. Cardiff & Vale UHB has been allocated
funding of £537k for 2015/16 to support the two schemes proposed as follows.
Scheme Name and Description, WG Allocation for 2015/16
1. Pathway transformation as identified via Cluster Plans
– Building upon the priorities as identified by the cluster plans, with a
focus on unscheduled care, develop a set of evidenced based
pathways that will support patients more safely and closer to home.
£367,000 WG allocation for 2015/16.
2. Increase dedicated prescribing advisor time in practice as
part of overall expansion of medicines management resource –
this will enable:
 Medication review of patients on polypharmacy
 Pharmacy expertise aligned to CRTs to provide specific support
to patients at risk of falls/requiring medication management
 Support of the practice in reviewing repeat prescribing processes
to ensure that they are safe and reduce waste.
 Bespoke work in practice on prescribing issues
Progress
Pathways reviewed and updated:
 Diabetes
 Advanced care planning
 Atrial fibrillation
 COPD
 Heart failure
 New pathways developed:
 Dehydration & gastroenteritis in U’5s
 Uptake of pneumovax & flu (At risk groups)
 Poly pharmacy related to falls
 Overarching Service Level Agreement developed
 Communication & agreement with Community Directors (CDs)
 Agreement of Primary Care Team Lead for co-ordination
 Development and consultation on Enhanced Service Specification
 Primary Care Lead development & commission of templates for monitoring
 Communication plan for practices developed.
 Recruitment open day held with good attendance
 A number of new posts offered and in the process of being recruited to
(Technician posts recruited to and the recruitment process continues for
Pharmacists, who should all be in post by January 2016)
 Ideas for improvement projects collated and prioritisation commenced
 Care Home Working Group being established.
£170,000 WG allocation for 2015/16 (note actions relating to this
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For more information on the WG Primary Care Investment in Cardiff and Vale, or to provide any
feedback please contact: Claire Watson on 02920 335395 or [email protected]
IHSC SIG 23.10.15
Attachment 3: Primary Care Developments
Scheme Name and Description, WG Allocation for 2015/16
Progress
also part of Primary Care Development scheme).
Primary Care Workforce Plan Investment
The Primary Care Workforce Plan was launched for on 17th July 2015, seeking views and feedback to be submitted by the 28 August 2015. Cardiff and
Vale UHB have since had confirmation of £504,000 investment to help support and implement the workforce Plan.
Scheme Name and Description, WG Allocation for 2015/16
1. Establishment of Primary Care Improvement Team – develop a dedicated multiprofessional Primary Care Improvement Team to work across a range of professions in
contractor and community services to sustain and modernise the workforce.
£122,453 WG allocation for 2015/16.
Progress
 DA submitted to Welsh Government
 Development of job descriptions
 Communication to practices from WG disseminated
information
 Engagement with the Local Medical Committee
2. Provision of dedicated Workforce Planning and OD expertise – this will allow:
 Develop workforce plans to stabilise and modernise the Primary and Community
services workforce
 Ensure effective knowledge sharing and transfer, and lessons learnt across clusters
and practices regarding new roles and ways of working for the primary care
workforce
 Promote the principles of prudent healthcare , and the role co-production can play in
a partnership approach to health and wellbeing
 Provide organisational development expertise to ensure that the potential of the new
investment combined with existing core services are maximised.
£29,324 WG allocation for 2015/16.
3. Pilot new innovative roles – New posts will be piloted in 2015/16 and evaluated to
assess the impact of these roles on the workforce looking to utilise different skills and
expertise to help improve access to the right professional quicker, these posts include:
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(LMC).
DA submitted to Welsh Government
Development of job descriptions
Work plan priorities developed
Communication to practices from WG disseminated
Engagement with the Local Medical Committee
(LMC).
 DA submitted to Welsh Government
 Development of job descriptions
 Discussion with Primary Care Out of Hours staff.
 Clinical Practitioners (Paramedics) – GP Out of Hours (OoH)
 Pharmacists – GP OoH
 Clinical Nurse Practitioners – GP OoH
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For more information on the WG Primary Care Investment in Cardiff and Vale, or to provide any
feedback please contact: Claire Watson on 02920 335395 or [email protected]
IHSC SIG 23.10.15
Attachment 3: Primary Care Developments
Scheme Name and Description, WG Allocation for 2015/16
Progress
and should help support the unscheduled care (USC) system through the winter period.
£38,503 WG allocation for 2015/16.
Cluster Investment
For Cardiff and Vale UHB, our share £848,000 was allocated across nine clusters (neighbourhoods). Schemes include the following:
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enhanced reviews of heart failure
enhanced reviews of dementia
cluster based pharmacists to undertake medication reviews of housebound elderly frail
COPD home education lifestyle programme
working with Third Sector to run patient participation programmes
collaboration across some clusters to offer an echocardiography service
equipment to support care in primary care such as ambulatory blood pressure monitors, point of care testing and cameras for teledermatology
As per the guidance from Welsh Government, investment is aligned to the cluster plans and the needs to the specific populations in that cluster area.
3.
Summary
In progressing the Welsh Government Primary Care investment programme, a number of significant achievements have been made by projects in a
short period of time. Of note:
 Two highly successful recruitment open days have been held, to publicise the new community posts being advertised, one session targeting
prescribing staff, the second targeting CRT staff. In total over 100 individuals attended these sessions.
 The CRT 7/7 working has successfully held three pre-consultation focus groups to ensure staff buy in and early engagement in the extended hours
proposal. The service is now formally consulting on 7/7 working.
 The new Nursing Home Local Enhanced Service (LES) has gone out to practices for sign up
 The appointment of an Optometric Advisor to act as the ‘Clinical Champion’ for primary care providing professional and technical advice to support
the development of pathways and engagement, with successful engagement and links made with Cluster Lead GPs
 Successful development of evidence based pathways, overall service specification, ongoing engagement with clusters and the Local Medical
Committee (LMC) on the proposed roll out and IT template development.
 Cluster funding has led to investment aligned to the specific needs of populations
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For more information on the WG Primary Care Investment in Cardiff and Vale, or to provide any
feedback please contact: Claire Watson on 02920 335395 or [email protected]