The British Medical Association (BMA) Wales has previously accused Welsh Health Boards of ‘playing lip service to GP cluster networks’, stating clusters lacked the support and resources to do the job. What are GP cluster networks, why are they important and what has been the pace of change?
The National Assembly’s Health, Social Care and Sport Committee will today, be holding their first oral evidence session on this issue.
Welsh Government’s plan for a primary care service for Wales up to March 2018
In February 2015, the Welsh Government published its plan for a primary care service for Wales up to March 2018. The plan is all about securing the success of primary care services for the future. It makes clear that general practice is a core element of primary care but it is not the only element – primary care encompasses many more health services, including, pharmacy, dentistry, optometry and a wider range of community services. The plan states that primary care services need to be delivered through a re-modelled workforce. It states that:
Where the GP’s role today is to diagnose and treat the vast majority of people who come through their own practice’s doors, in the future, their role will increasingly be to collaborate with other local health services through the primary care clusters to provide overarching leadership of multi-professional teams organised to improve population health and provide access to care to meet the needs of individuals, families and local communities at the right time in the right place (A national plan for a primary care service for Wales, February 2015, p,20).
It also states:
In this new workforce model, GPs will continue to play a pivotal role, taking responsibility for professional standards, providing clinical leadership and working directly with those patients with complex needs, which can only be met by a GP’s skills (p,2).
Primary Care Clusters
The national plan for a primary care service for Wales up to March 2018 reinforces the importance of co-ordinating care and planning services at a community level. Health Boards have created local planning mechanisms by clustering several adjacent GP practices together using their combined registered populations to create a small local planning population. There are 64 of these primary care clusters (also known as GP clusters) across Wales. The annual changes to the national GP contract are being used to encourage GP practices to agree and deliver actions plans to ensure the sustainability and quality of their services.
Each Health Board has to develop three-year integrated medium term plans, which should explicitly reflect their primary care clusters’ plans. Primary care clusters in each Health Board have each developed cluster development plans which are published on the NHS Wales website. Every Practice in Wales also publish individual practice plans as part of their requirements under the national GP contract (Quality Outcomes Framework).
The primary care cluster and health board plans set specific goals and actions for improving access to and the quality of primary care to deliver improved health and wellbeing and reduced health inequalities. As well as planning and delivering more primary care services to meet local need, primary care clusters will also play a significant role in planning the transfer of services and resources out of hospital and into their local communities for the benefit of their local populations.
The national plan for a primary care service for Wales up to March 2018 plan states:
Collaboration through primary care clusters creates better opportunities to take an innovative approach to designing primary care. Innovation in primary care is about generating new funding models, new service models and workforces roles, new ways of contracting and new partnerships with communities and the third and independent sectors. Innovation also includes new technology, products and services, and working with universities and industry to accelerate innovation and to support economic growth in Wales. It is about making the best use of buildings to promote professionals working together (p,10).
The Welsh Government make clear that they expect health boards to support their primary care clusters to implement actions and key milestones to support their sustainable, rapid ongoing development. Health Board Directors of Primary, Community and Mental Health are responsible for delivering a co-ordinated national approach to supporting innovation in primary care, including structured support mechanisms, systematic evaluation of new ideas and good practice, and prioritised funding for innovative ways of delivering care and improving access.
The Health, Social Care and Sport Committee’s Inquiry will focus on the role of clusters as a means of transforming primary care. The Committee’s Inquiry aims to provide a better understanding of how the cluster model is working in Wales and will consider:
- How GP cluster networks in Wales can assist in reducing demand on GPs and the extent to which clusters can provide a more accessible route to care (including mental health support in primary care).
- The emerging multi-disciplinary team (how health and care professionals fit into the new cluster model and how their contribution can be measured).
- The current and future workforce challenges.
- The funding allocated directly to clusters to enable GP practices to try out new ways of working; how monies are being used to reduce the pressure on GP practices, improve services and access available to patients.
- Workload challenges and the shift to primary prevention in general practice to improve population health outcomes and target health inequalities.
- The maturity of clusters and the progress of cluster working in different Local Health Boards, identifying examples of best practice.
- Local and national leadership supporting the development of the cluster infrastructure, how the actions being taken complement those in the Welsh Government’s primary care plan and 2010 vision, Setting the Direction.
- Greater detail on the aspects being evaluated, the support being supplied centrally and the criteria in place to determine the success or otherwise of clusters, including how input from local communities is being incorporated into the development and testing being undertaken.
You can follow today’s proceedings on Senedd TV from 9.45am.
Article by Sarah Hatherley, National Assembly for Wales Research Service.