Like other parts of the health system, primary care needs careful planning to help shape the way in which services are delivered. However, planning for primary care cannot be done in isolation and must instead be part of a whole system approach to the design and delivery of health and social care services
The most recent national primary care plan [PDF opens in new window] aims for a ‘social model’ that promotes physical, mental and social wellbeing, rather than just an absence of ill health. The plan has five priority areas:
The national plan says:
The national plan says access to a high-quality primary care service is about:
The national plan says:
The national plan says:
The national plan says:
The NHS in Wales is trying to change the way the public accesses primary care services. Traditionally, GPs have been the first port of call for people with healthcare needs, and have acted as a ‘gatekeeper’ to other services. In future, the aim is that patients’ will be able to access a wider range of healthcare professionals, depending on their needs. This will help ensure GP time is used to best effect in the context of growing demand for primary care services.
The Welsh Government introduced the National Primary Care Fund in 2015-16 to encourage innovation and improvement.
The fund in 2016-17 was £41 million including £10 million for clusters and £3.8 million for pathfinders and pacesetters.
Clusters are groups of neighbouring GP practices and partner organisations (such as the ambulance service, councils and third sector) which provide services for their local populations of between 30,000 and 50,000 people. Clusters have a key role in supporting local health needs assessments, allocating appropriate resources and forecasting the potential future demand on primary care.
The pathfinders and pacesetters are a range of primary care projects, sponsored by Welsh Government, that aim to test elements of the primary care plan. This approach has produced some new ways of work that have been collated into the Transformational Model of Primary and Community Care.
Key elements of the model include: sustainability in general practice, shared triage processes, multi-disciplinary teams working across practices, integrated working between health, social care and the third sector, improved access and a better informed public.
The current approach to planning primary care is both ‘top-down’ (ie common priorities set out in the national plan) and ‘bottom-up’ (ie planning and innovation led by local practices and clusters). This means that there are various plans, at various levels, that need to make sense and complement one another.
Patient goes to the GP as first point of call.
GP is gateway to other services.
Many other services will provide the first port of call for patients, freeing up GPs to see the sickest patients. GPs will continue to be the first port of call for most urgent care
These services will work as a team and patients are likely to access them through a shared triage/assessment service.
Public expectations will have to change: In future, patients will be less likely to see their GP, and instead will be more likely to see a different professional. One approach being tried is to introduce a central triage process to ensure patients are seen by the most appropriate clinician. But Healthcare Inspectorate Wales reported that patients can be unhappy with such steps, “feeling that it removes choice.”