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What is the plan to improve primary care?

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

Previous plans for primary care

NHS Wales reports

  • NHS Wales has had plans for many years that stress the importance of primary care. The plans aim to rebalance the system of care in Wales by moving resources towards primary and community care.
  • In 2001, the Future of Primary Care [PDF opens in new window] planned to reverse the ‘relative under-development of primary care in Wales’. The vision included team-based working, more integration and a greater focus on prevention.
  • In 2017, the Welsh Government’s national strategy [PDF opens in new window] talks about the need to accelerate the shift towards moving care closer to patients’ homes.

The most recent plan for primary care

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:

Planning care locally

The national plan says:

  • Health boards are responsible for identifying the needs of their population.
  • This should be done at a community level.
  • The plan talks about more local autonomy for leadership, collaboration and innovation.
  • clusters are a key part of achieving this.

Improving access and quality

The national plan says access to a high-quality primary care service is about:

  • Information, advice and assistance to support and motivate people to take responsibility for their own and their family’s health and wellbeing.
  • Diagnosis, investigation, treatment and continuity of care as close to home as possible.
  • Professionals working together as a coordinated team around the person.
  • Continuous improvement.
  • Openness and transparency.

Equitable access

The national plan says:

  • Equitable access to primary care is about a proactive, proportionate and individual approach to improving the physical and mental health and wellbeing of individuals, families and communities.

A skilled local workforce

The national plan says:

  • Primary care is fundamentally about trusted relationships between people and professionals. We need to plan and build a workforce with the right numbers and mix of skills to meet the majority of people’s needs closer to home in flexible ways and flexible facilities.

Strong leadership

The national plan says:

  • We need to strengthen and develop leadership at all levels to deliver this plan to provide more care closer to home through primary care services.

Planning to meet demand for primary care

  • The national primary care plan says ‘austerity is driving a wave of demand into primary care on an unprecedented scale’. The plan also says that primary care is facing increasing and more complex demands due to an ageing population, and increases in long-term conditions.
  • If health boards are to meet demand for, and improve access to, primary care, they need a good understanding of this demand. However, there are some fundamental issues with the data.
  • The exact number of contacts that patients have with GP surgeries is not known at a national level because the data is held in the computer systems of individual GP practices and there are difficulties collating this information. Estimates range from 16 million to 23 million per year.
  • There is better data in other parts of the primary care system, mainly because these services are paid depending on their activity:
    • In 2016-17 the 716 community pharmacies in Wales dispensed 74.7 million prescription items to patients.
    • In 2016-17, community optometrists performed eye tests on 776,827 people.
    • In the two years up to 31 March 2017, more than 1.7 million people visited a dentist for NHS treatment.

Changing the way we access services

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.

Innovation and a new model for primary care

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.

In the past

In the future

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.”

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