The Strategic programme for primary care in Wales

PCC caught up with Alan Lawrie who is the national programme advisor (primary care) for the strategic programme for primary care. Alan updated us on the purpose of the strategic programme, its key aims and functions and how the accelerated cluster development (ACD) work has been rapidly evolving.

Strategic programme for primary care (SPPC)

The SPPC is an all-Wales health board-led programme that works in collaboration with Welsh Government and responds to A Healthier Wales. The programme commenced in November 2018 and is in its fifth year of operation.

The programme aims to bring together and develop all previous primary care strategies and reviews at an accelerated pace and scale, whilst addressing emerging priorities highlighted within A Healthier Wales.

To achieve success, the programme looks to all health, social and wellbeing providers, health boards and other stakeholders to work collaboratively in sharing local initiatives, products and solutions that could add value to the delivery of primary care services on a ‘once for Wales basis’.

There are six strategic programme work streams: Prevention and workstreams, 24/7 model, Data and digital technology, Workforce and organisational development, Communications and engagement, Transformation and vision for clusters

Key to the success of the programme is support, engagement and collaborative working across all independent contractors, clusters, health boards and wider stakeholders.

Four key strategic priorities were identified to shape the work programme:

• Accelerated cluster development (ACD)
• Urgent primary care (UPC)
• Community infrastructure (CI)
• Mental wellbeing

These four strategic priorities are delivered through the six existing workstreams of the strategic programme.

Primary care clusters have been in place in Wales since ‘Setting the Direction’ was published in 2010. This set out that community networks would be formed in order to co-ordinate and improve care in the local community and bring patients out of hospital into co-ordinated community services closer to home. It also stated there needed to be improvement in the primary and secondary care interface and that patients should be able to obtain reliable and accessible services wherever they live. A cluster brings together all local services involved in health and care across a geographical area, typically serving a population between 25,000 and 100,000. Working as a cluster ensures care is better co-ordinated to promote the well-being of individuals and communities.

Accelerated cluster development (ACD

The SPPC includes a key work-stream to support the development of clusters within Wales. This is in part a response to the Inquiry into Primary Care Clusters undertaken by the Health Social Care and Sport Committee in late 2017, and the subsequent Welsh Government response. The inquiry found that a major step change was needed if clusters were to have a significant impact and a role in delivering Welsh Government ambitions for primary care. There also concluded there was limited evidence that the cluster model had reduced pressure on general medical services and secondary care, and that there was a significant variation in maturity across Wales. The recommendations called for a refreshed model for primary care clusters with a clear vision.

The ACD programme is looking to achieve:

• Clarity of purpose of clusters (planning & delivery).
• Clusters influencing mainstream planning and decision making.
• Bring local authority and other stakeholders together with clusters.
• Ability to deliver local approaches to health board and regional partnership strategy.
• To meet cluster population health need through effective and robust planning and service delivery.
• Local flexibility based upon local circumstances.
• Ability to consider / influence total spend in a cluster / pan cluster footprint.
• Once for Wales solutions for contracts (if required).
• A direction of travel for local implementation.

One of the key outcomes of the ACD programme includes the introduction of professional collaboratives (PCs) and pan cluster planning groups (PCPGs) to broaden and strengthen clinical engagement and to increase the influence from the community to regional partnership board (RPB) (health board and local authority) decisions.  A clearer separation of planning and delivery functions will be developed.

Some of the key functions that are being introduced as part of the ACD programmes include:

• Professional collaboratives – These are the groups that will be set up for GP practices, dental practices, community pharmacies, optometry practices, community nurses, allied health professions, social services and others to come together within their profession specific groups across a cluster footprint to consider how they respond to regional population needs assessments, consider the quality of their service offer and look at how they respond to national strategy for their respective profession, designing local solutions based upon their detailed knowledge and expertise. 2022/23 was the transitional year to get these established and fully operational, with local teams determining the best way of setting these up within the local footprint. Some have been set up at cluster level, with others across a wider footprint.
• Pan cluster planning groups – These groups are set up so representatives of clusters can come together at county population footprint to collaborate with representatives of health board and local authority, public health experts, planners and representatives of those services for which Professional Collaboratives are not appropriate e.g. services which should only be planned at county, health board/regional or even national level.

PCPGs will provide the local footprint for the delivery of RPB priorities. PCPGs agree a county population needs assessment and a plan on what services are needed, making prudent use of all funding, workforce, and other resources.  PCPG assessment of needs and plans must inform and be informed by regional level assessments of need (which are a statutory function of RPBs).

Resources to support SPPC

During 2022/23 43 documents and communications were been developed to support the introduction and understanding of the strategic priorities including the ACD programme, including this summary diagram which can be viewed in full on the primary care one website.

Other resources include:

• ACD toolkit – The toolkit is a collection of information and adaptable resources for stakeholders who will be supporting and driving forward the implementation of the ACD programme. It will enable stakeholders to learn more about the ACD programme, its components and access tools to support local delivery. The toolkit can be found here.
• Gwella leadership portal – This online portal is run by Health Improvement Wales (HEIW) and provides a range of digital leadership materials, resources, networks and support. It allows users to access a range of compassionate leadership resources with ease.

2023/24 and beyond

Outcomes remain unchanged with five key programmes of work delivered through coordinated activity across the six strategic programme workstreams.  The five programmes are:

• Mental Wellbeing – building the primary care model of mental health assessment and support that removes the artificial separation between mental and physical health and minimises overmedicalisation.
• Community Infrastructure – developing fully coordinated neighbourhood teams with the capacity to promote health and wellbeing and maintain out of hospital care in all ‘home’ settings.
• Urgent Primary Care – progressing the development of simple, fully integrated same day response models for each community.
• Accelerated Cluster Development – building on the local understanding of population needs, strengthening the coordinated use of all available resources and providing clear analysis of service gaps.
• Primary Care Workforce Strategy – translating the shared vision into a clear roadmap to drive resource allocation, recruitment and retention actions, including an increased focus on workforce wellbeing and career flexibility.

The ultimate aim is to have the sets of organisational arrangements embedded into primary care, where there are strong cluster leads influencing the planning of services for their local community.  They have begun to respond or have already responded to needs that they have identified both from there clinical practice but also from the population needs assessment and that’s demonstrable and there has been a demonstrable shift in relation to service delivery, in and out of hospital, in the community space.

There are PCPGs in operation which are multi-agency, delivering multi agency services so that you have a raft of services across Wales that are being delivered in a very unique, innovative and agile way giving a better outcome for patients.

Further information and updates on the SPPC can be found on the primary care one website.