The 3 rd Annual National Primary and Community Care Conference Conference Report 15 November 2018. All Nations Centre, Cardiff
Introduction For 90% of the people living in Wales, primary care is the first point of contact, night or day, to NHS services. In meeting the health and wellbeing needs of the population of Wales co-ordinating access to the extensible range of health and social services in local communities is essential. This report is of the 3 rd annual national conference dedicated to primary care. The theme this year was access to primary care services. Conference programme The 2018 conference, attended by over 300 delegates from across Wales, was chaired by Dr. John Boulton, Interim NHS Director of Quality Improvement and Patient Safety / Director of 1000 Lives Improvement. The agenda and conference resources are available online under the Events or Resources sections of Primary Care One. Conference opening Dr. John Boulton opened the conference by highlighting how conferences in previous years have focussed on developing a new model of primary care. For this conference a notable shift towards exploring how the model is having an effect and recognising and celebrating the work achieved so far in primary care was observed. The citizen s voice The first plenary presentation was made by Clare Jenkins and Alyson Thomas, Joint Chief Executives, Community Health Council (CHC) who described the role of the of the CHC in supporting change. A series of short films of patients in Wales describing their experiences of primary care services across Wales, and in particular issues with access were shown. This session provided an opportunity for the audience to listen to the views of the public from a lay perspective on recent developments in primary care. The summary of key points from the presenters: CHCs works in partnership with the NHS and welcomes primary care discussions People care passionately about local primary care services hence significant change is not always well received The public recognise the pressure NHS services and the staff are under and want to be part of a conversation around change People need to understand how changes work for them People matter and whatever the model, the NHS makes patients feel safe The presentation, film 1, film 2 and film 3 are available online under the Events or Resources sections of Primary Care One. 2
Operation GMS - the road back from ITU Charlotte Jones, Chair GPC Wales described the picture of General Practice today and how contract changes and resulting investment past, present and future has been and continues to be fundamental in maintaining GP engagement and sustainability of the workforce. The potential to improve the population s health offered through cluster working and the increasing role of the Regional Partnership Boards in the transformation agenda was highlighted. Public engagement driven locally, regionally and nationally was recognised as vital in transforming primary care. The presentation is available online under the Events or Resources sections of Primary Care One. Cabinet Secretary Address Vaughan Gething AM, Cabinet Secretary for Health & Social Services opened his session by describing how many people in Wales value and are grateful for the health service they receive most of time. He described the NHS as a trusted organisation and how some people in Wales getting angry at criticism the service (NHS) receives. The Cabinet Secretary took time to describe how the ambition of A Healthier Wales was for everyone to have longer, healthier and happier lives. He further noted the role of primary care in realising the ambition as being crucial considering 90% of patient contacts being made in a primary care setting. There was recognition for General Practice being at the core of primary care services and the importance of sustainability of this workforce. The national stated-backed indemnity provision for GPs in Wales was cited as a recent example of methods to attract and retain the GP workforce in Wales. When considering the transformation of primary care in general the Cabinet Secretary commented on the following: The need for a whole system approach; How people and service users are central to service redesign and the importance of working together with service users to reshape the system; How, irrespective of changes, the health and social care system will continue to be complex and in order to achieve more informed citizens there is a need to help navigate people through the system; How by delivering the new model for primary care everyone should do a better job and enable a better experience for public; As service providers and users we can chose whether change happens to us or allow it to happen to us. The Cabinet Secretary noted the many examples of exemplar and innovative practice observed during his practice visits around Wales. He also shared his frustration that the 3
developments observed are not yet Wales wide and questioned why a multidisciplinary model can work in some places but not everywhere. When discussing enablers the following points were highlighted: The Transformation Fund as an investment opportunity to scale up islands of good practice ; The need for the new model of primary care to feature strongly in health board plans; How the new model of primary care needs to be embraced by everyone to ensure greater scale and pace; The importance of setting delivery milestones (based on components of model) to help facilitate change and how much of this will be delivered through the Strategic Programme for Primary Care. The need to foster a culture of measuring the right things and possibly different things across the health system. In particular, how the current landscape of most measures being hospital based despite most interactions with the health service being in primary care. The Cabinet Secretary introduced the concept of a new whole system indicator time spent at home and queried if and how this could be described and measured in Wales. Despite having to leave the conference early, the Cabinet Secretary indicated he was looking forward to feedback from conference, and asked everyone to get behind the Strategic Programme for Primary Care. The Strategic Programme for Primary Care is available online under the Events or Resources sections of Primary Care One. Transforming access This session, chaired by Paul Gimson, Programme Lead 1000 Lives Improvement, provided an opportunity to explore the roles of the four independent contractor professions, Community Pharmacy, Community Optometry, General Dental Services and General Medical Services. The session theme was improving access and transforming primary care for citizens in Wales. Presentations were given by front line staff who described current developments, innovation and improvements and the impact these are having for their patients and customers. This session concluded with the presenters being joined by national professional policy leads to participate in a panel question and answer session. 4
Q and A themes Cross professional working necessary to relieve pressure in general practice and improve access and services for citizens of Wales. Joined up national leadership essential to lead contractual reform and investment in multi-professional training such as prescribing and quality improvement. The range of support available for patients with complex needs but lack of understanding of why people aren t accessing all the services available to them. Enhanced service provision as both an enabler and barrier. The tension between patients valuing continuity with a healthcare professional and a MDT model where a patient s management may be managed by multiple professionals. The clear challenge to keep the energy and motivation going in clusters that are both progressing at great pace and those just starting off. Recognition of governance frameworks but a danger care of inventing 64 mini health boards. Funding movement essential in allowing clusters to flourish and appreciating clusters involve a health, social care and third sector professionals. The job satisfaction expressed by professionals taking on new roles and the desire to do more often requires investment in equipment, training, estates etc. and the risk in investment only worthwhile if the health board commissions in the new services. Recognition from the contractors that the model of business is changing and investment means opportunity (individual contractor, corporate and NHS). Access to patient records essential and recognition that developments are already in place to progress this, for example, community pharmacies already have access to selected GP records and work is ongoing to provide 2 way communications and work is progressing to facilitate the sharing of clinical optometric information between primary and secondary care records. The requirement to scale up innovation and embed in routine processes by influencing other parts of the system, for example, how in one area a practice nurse training scheme pacesetter project could influence the redesign of nursing courses in to mainstream skills. Presenters included Dylan Jones, Dudley Taylor Community Pharmacy in Llanidloes, Andy Britton, Specsavers in Haverfordwest, Richard Jones, Belgrave Dental Practice, Swansea and Dr. Gaynor Thomas, Pont Newydd Surgery, Porth. National policy leads on panel included: Andrew Evans, Chief Pharmaceutical Officer, Welsh Government, Sharon Beatty, Clinical Lead and Training and Accreditation Manager, Eye Health Examination Wales, Colette Bridgeman, Chief Dental Officer, Welsh Government and Andrew Havers, Senior Medical Officer for Primary Care, Welsh Government. Presentations are available online under the Events or Resources sections of Primary Care One. Transforming access through multi professional care Philippa Ford, Public Affairs and Policy Manager for Wales, Chartered Society of Physiotherapists opened this session by highlighting developments in multidisciplinary professional team (MDT) working across primary care. The benefit these roles can provide in supporting patients and other professionals was described and reference was made to the MDT review which investigated the contribution of MDT roles in improving access in primary care. The Strategic Programme for Primary Care are considering the recommendations of the review. 5
A series of lightening presentations, given by front line multi-disciplinary staff from across Wales, were introduced by Dr. Jane Harrison, Lead GP Advisor, Primary Care Division, Public Health Wales. This session provided a flavour of the evidence base for such roles, the contribution the new roles can offer to the transformation agenda and the challenges experienced to date in developing these roles. The panel questions and answer session planned as per the agenda was replaced with an opportunity for table discussion about the future of multi-professional team working based around two questions. Questions to facilitate table discussions What are the main actions required at a national level to develop cluster MDTs across Wales? What messages and actions could you take back to your organisation to help drive local cluster MDT development? A report of the collated responses to the table discussions is available online under the Events or Resources sections of Primary Care One. Presenters included: Amanda Monsell, Advanced Nurse Practitioner, Natalie Phillips, Audiologist, Ian Wile, Director of Operations, Mental Health, Kerrie Phipps, Occupational therapist, Grayham Mclean, Paramedic, Robert Caine, Physiotherapist, Liesbeth Beeckman, Social Prescriber, Allison Hulmes, BASW Cymru representing Social Worker and Victoria Lloyd, Age Cymru. Presentations are available online under the Events and Resources section of Primary Care One. The report: Multi-Professional Roles within the Transforming Primary Care Model in Wales, August 2018 is available online under the Events and Resources section of Primary Care One. Technology to improve access and sustainability Chaired by Paul Gimson, Programme Lead 1000 Lives Improvement, delegates witnessed a panel conversation between key individuals with experience of technology in primary care in Wales and England. The discussion focussed on exploring how improvements in digital technology can help primary care to improve access and sustainability. 6
The following issues arose during the conversation: The importance of seeing advancements in digital technology from a patient s point of view. Consideration for the 40% of the over 65 year olds in Wales who are not digital literate and therefore can t fully access services available online; The support available to help people who are digitally excluded to use the internet and get online through initiatives such as the Digital Communities Wales: a social enterprise facilitating 2000 Digital Heroes (volunteers 7-11 year old) with skills to support others in the community to get online; Examples of existing and innovative practice across the UK such as websites, App developments, My Health Online, GP text messaging services and Skype; Lessons learned with experiences and use of the aforementioned digital technologies and initiatives; The importance of making best use of routinely available and widely acceptable forms of communication such as the telephone and telephone triage systems; Positive advancements with DEWIS thereby enabling citizens and professionals to access directory of services online; The session concluded with a questions and answer session for the panel members. Q & A session Questions from the audience focussed on electronic prescribing (EP) developments and future plans for this in Wales. There was strong feeling from delegates that EP would be a positive way forward and is the solution for many issues facing prescribers in Wales and yet is not being progressed. Anne Marie Cunningham highlighted recognition of the huge change over recent years, facilitated by IT, from a situation of manual transcribing improving many aspects of prescribing and medicines management. Despite panel members understanding and hearing the delegates frustrations in the delay of introducing EP in Wales, the argument for prioritisation of EP was not universally accepted and supported by all panel members. Dr Damian Williams, in particular, reflected that in his experience of having access to electronic prescribing in England, it is not perfect and although appears be getting better EP may not be the solution to problems people perceived it to be. Anne Marie Cunningham suggested the need for clear articulation of the problems of existing prescribing systems and the benefits for professionals and patients electronic prescribing to be identified to influence progress and developments. Karin Philips, Deputy Director Primary Care, Welsh Government suggested the need to open up the conversation about EP with stakeholders again as this has been a topic for discussion a number of times over recent months. 7
Panel included: Dr Anne Marie Cunningham, NHS Wales Informatics Service (NWIS); Richard Palmer, Data Cymru; Dr. Heather Potter, Neath Primary Care Hub, Antonia Higgins, Brynderwen & Minster surgeries, Cardiff, Darryn Thomas, Betsi Cadwaladr UHB Central Area, Matthew Lloyd, Digital Communities Wales, Dr Steve Bassett, GP out-of-hours lead for 111 Wales and Dr Damian Williams, Hall Green Health, Birmingham, Primary Care Clinical Information Officer for BSOL CCG, Your Care Connected clinical lead and Digital Clinical Champion with NHS England. Panel member s details and additional information is available online under the Events and Resources sections of Primary Care One. Reflections and next steps Judith Paget, CEO Aneurin Bevan UHB, Lead Chief Executive for Primary Care and Chair of the National Primary Care Board reflected on the conference and the day. She celebrated how five years ago the focus was about getting primary care on the agenda whereas this conference indicated that primary care now had a much stronger focus than ever before. The many examples of innovation and sharing of good practice during the day were recognised. The wish from the Cabinet Secretary for good practice to become standard practice was noted together with the opportunities now afforded for improvement of health care through redesign and the pivotal role primary care has in that change. The audience were reminded of the Strategic Programme for Primary Care and how the work will be progresses and challenges identified during the day addressed through work streams of that programme. Thanks were given to everyone for their contribution, support and participation during the conference. Private audience with Director General During the day Andrew Goodall, Director General Health and Social Services and NHS Wales Chief Executive, invited representatives from health boards, clusters and Regional Partnership Boards to attend one of two closed sessions. This provided an opportunity to meet in an informal manner to share achievements, discuss challenges, next steps for clusters across Wales and the links to Regional Partnership Boards and the wider community infrastructure to support the wellness system. Karin Phillips, Deputy Director Primary Care Division, Welsh Government and Sue Morgan, Director of Primary Care, NHS Wales were also present. The outcomes of these sessions were to be feedback to the Cabinet Secretary and shared with the Directors of Primary and Community Care to consider the enablers and next steps within the work streams of the Strategic Programme for Primary Care. Conference close The conference was closed by the Chair, Dr John Bolton who thanked everyone for their contribution and participation during the day. The world has changed while we ve been in this room. John Bolton 8
Exhibitors During refreshments and lunch, a marketplace provided an opportunity for health boards and other organisations from across Wales to highlight their progress in transforming primary care, supporting access and the new model for primary care. Exhibitors at the conference, listed in alphabetical order: Abertawe Bro Morgannwg University Health Board Aneurin Bevan University Health Board Betsi Cadwaladr University Health Board British Dietetic Association Cardiff and Vale University Health Board Chartered Society of Physiotherapists Cwm Taf University Health Board DEWIS Hywel Dda University Health Board Health Education and Improvement Wales Low Vision Service Wales NHS Centre for Equality and Human Rights NHS Wales Collaborative Cancer Network NWIS Primary Care Services/Choose Pharmacy NWSSP Primary Care Services Powys Teaching Health Board Public Health Wales Help Me Quit Public Health Wales Primary Care Division Public Health Wales 1000 Lives Improvement Royal College of Speech & Language Therapists Welsh Ambulance Service NHS Trust 111
The event on social media A series of planned English and Welsh social media posts were shared in the week running up to the conference as well as during the event. A number of on-the-day posts were also shared with accompanying photos. Facebook activity English: 1 post, 1.2k reach, 42 clicks, 9 likes, 3 shares Welsh: 1 post 42 reach Twitter activity English: 13 posts, average 1,497 impressions per post, most successful tweet received 3,476 impressions, 106 uses of #PrimaryCare18. Welsh: 13 posts, average 81 impressions per post. #Primarycare18-106 users of the hash tag on the day 10