Despite considerable investment and many plans for primary care transformation over the years, change has not happened as quickly or as widely as intended.
While the NHS and Welsh Government are taking a range of steps to strengthen primary care, change needs to happen at greater pace and scale to tackle longstanding challenges and ensure vital services are fit for the future. That’s the key message of a report by the Auditor General for Wales.
There remains growing pressure on the traditional model of primary care and patients are experiencing continued difficulties in accessing appointments with a GP. The proportion of people finding it difficult to get an appointment decreased slightly from 42% in 2017-18 to 40% in 2018-19 although this level remains of concern and varies across Wales.
In recent years there have been a number of developments that have sought to strengthen the planning and delivery of primary care services in Wales. Most notably this has included the establishment of primary care clusters (see notes to editors) and the introduction of a National Primary Care Fund that allocated £120m to health boards between 2015-16 and 2017-18 to support the development of primary care through various initiatives including the national pacesetter programme (see notes to editors).
During the last few years a new Primary Care Model for Wales has evolved, which promotes the development of multi-professional primary care teams to reduce the current pressures on GPs and to improve access and services for patients. However, progress on implementing the model is patchy and the pace of change needs to be increased.
The new primary care model is beginning to be implemented but there is a need for better engagement with the public to ensure they understand the new ways of working. There is also a need to increase awareness, understanding and support for the model amongst NHS staff, who can guide patients to the right service and act as advocates for the new ways of working.
The report sets out national-level recommendations for Welsh Government and the National Primary Care Board, including:
- Consulting with health boards, to agree an approach to clarify and standardise the way that primary care expenditure is recorded and reported; and
- Driving implementation of the Primary Care Model for Wales and developing, collecting and publishing regular data to help gauge progress;
- Involving the public more in primary care changes.
Auditor General, Adrian Crompton said:
“Primary care services play a vital role in the system of health and care in Wales. Whilst there has been a range of plans to develop primary care, progress in implementing these plans has been limited and primary care has not always had a high enough profile within the NHS in Wales.
This has to change, and the new model that is envisaged for primary care needs to be rolled out at a quicker pace and on a larger scale, and with appropriate engagement of staff and service users. Failure to do so will create some real challenges to the sustainability of these vital services.”
Notes to Editors:
- This report focuses on the main issues and areas of progress found in primary care services in Wales on a national-level.
- Primary care covers a wide range of services, delivered by GPs, pharmacists, dentists, optometrists and professionals from health, social care and voluntary sectors.
- Primary care clusters – clusters are groups of neighbouring GP practices, other primary care services and partner organisations who work together to ensure care within a defined geographical area is better co-ordinated. There are 64 clusters in Wales, typically serving a population of between 25,000 and 100,000 people.
- The Pacesetter Programme – the programme aims to stimulate innovation and promote primary care redesign. It began with 24 projects, which employed different practitioners, including pharmacists and physiotherapists, to work in GP practices to try out new, innovative ways of providing primary care services.
- During 2018, we reviewed primary care services in all health boards in Wales focussing on strategic planning, investment, workforce, oversight and leadership, and performance.
- In early 2019, we carried out interviews and document reviews to assess the national leadership and governance arrangements for improving primary care.
- The Auditor General is the independent statutory external auditor of the devolved Welsh public sector. He is responsible for the annual audit of the majority of the public money spent in Wales, including the £15 billion of funds that are voted on annually by the National Assembly. Elements of this funding are passed by the Welsh Government to the NHS in Wales (over £7 billion) and to local government (over £4 billion).
- The audit independence of the Auditor General is of paramount importance. He is appointed by the Queen, and his audit work is not subject to direction or control by the National Assembly or government.
- The Wales Audit Office (WAO) is a corporate body consisting of a nine member statutory Board which employs staff and provides other resources to the Auditor General, who is also the Board’s Chief Executive and Accounting Officer. The Board monitors and advises the Auditor General, regarding the exercise of his functions.