DRAFT

2016 Version 0a 1

Cluster Network Action Plan 2016-17

(Third year of the Cluster Network Development Programme)

Anglesey Cluster

The Cluster Network1 Development Programme supports GP Practices to work to collaborate to:

• Understand local health needs and priorities.

• Develop an agreed Cluster Network Action Plan linked to elements of the individual Practice Development Plans.

• Work with partners to improve the coordination of care and the integration of health and social care.

• Work with local communities and networks to reduce health inequalities.

The Action Plan should be a simple, dynamic document and in line with CND 002W guidance.

The Plan should include: -

Objectives that can be delivered independently by the network to improve patient care and to ensure the sustainability and modernisation of

services.

Objectives for delivery through partnership working

Issues for discussion with the Health Board

For each objective there should be specific, measureable actions with a clear timescale for delivery.

Cluster Action Plans should compliment individual Practice Development Plans, tackling issues that cannot be managed at an individual

practice level or challenges that can be more effectively and efficiently delivered through collaborative action.

1

A GP cluster network is defined as a cluster or group of GP practices within the Local Health Board’s area of operation as previously designated

for QOF QP purposes

DRAFT

2016 Version 0a 2

To understand the needs of the population served by the Cluster Network

The Cluster Profile provides a summary of key issues. Local Public Health Teams can provide additional analysis and support. Consider

local rates of smoking, alcohol, healthy diet and exercise – what role do Cluster practices play and who are local partners. Is action

connected and effective? What practical tools could support the delivery of care? Health protection- consider levels of immunisation and

screening- is coverage consistent- is there potential to share good practice? Are there actions that could be delivered in collaboration-

e.g. Community First to support more effective engagement with local groups

No Objective For completion by: - Outcome for patients Progress to Date

1 To review the needs of the

population using available data

To ensure that services are

developed according to

local need

2 To identify additional

information requirements to

support service development

Improved support for

service development

3 To consider learning from

previous analyses to identify

any outstanding service

development needs

4 To develop a plan to contribute

to the reduction in prevalence

of smoking

Improved health outcomes

Improved quality of life

PLEASE NOTE THIS PIECE OF WORK WILL BE SUPPORTED BY PUBLIC HEALTH WALES AND YOUR LOCAL AREA TEAMS

DRAFT

2016 Version 0a 3

POPULATION NEED (Priority 1 – Smoking Cessation)

Priority 1 The issues Aims and objectives How will this be done? Named Lead

Time Scale

Smoking

cessation

22% of adults smoke on Anglesey (2013/14). Although this shows a reduction from 2012/13, it is still above the North Wales average of 20%. Smoking is linked to social class and accounts for a high proportion of the inequalities in health outcomes. North-West Anglesey has the highest level of deprivation and had the highest level of smoking-attributable admissions in BCU. Quitting smoking offers better improvement to healthy life expectancy than almost any other medical or social intervention. NICE guidance is that 5% of adult smokers should be treated every year. This is now a Health Board Tier 1 target, with 40% quit rate. Although we have reached the 5% target our recorded quit rates are well below 40% Variable referral rates and access to smoking cessation services on the island.

Implementation smoking cessation pathway in all Practices: GP Practices are asked to signpost to specialist smoking cessation service such as Stop Smoking Wales or Pharmacy Level 3 as this is the most effective support for a successful quit. Increase demand for specialist smoking cessation services

Offer timely and appropriate support for all adult smokers who wish to make a quit attempt Try and improve quit rates Ensure tailored interventions and equity of access and outcomes for specific groups, such as pregnant women, manual workers, people with mental health problems and socioeconomically disadvantaged communities

PHW are undertaking work to map smoking cessation services across the island starting in Holyhead first.The objective is to ensure an integrated smoking cessation service across community, secondary care, mental health, social care, and other local settings. The smoking cessation integration project commenced in Holyhead in January 2016. The outcomes from this Integrated Smoking Cessation Service project and progress across the island to be shared with the Cluster Smoking cessation advice pathway to be available and understood by all members of each practice team on the island

PHW

SM

Ongoing over next 12 months

9 months

DRAFT

2016 Version 0a 4

POPULATION NEED (Priority 2 to be chosen by Cluster)

Priority 2 The issues Aims and objectives How will this be done? Named Lead

Time Scale

Obesity

29% of boys and 23% of girls aged 4-5 are overweight or obese in Anglesey, which is slightly over the BCUHB average. 57% (2012/13) adults on Anglesey are either overweight or clinically obese. 23% of adults are clinically obese and this figure has risen from 21% the previous year. Increasingly significant public health challenge

To ensure that there is a clear locality pathway to support individuals trying to lose weight Provide education for primary care staff

• All primary care professionals should be

aware of the ’10 steps’ advice

• Map organizations on the island already providing weight loss support

• Development of Childhood Obesity

Framework on the island

PHW

PHW

PHW

3 months

12 months

6 months

DRAFT

2016 Version 0a 5

ACCESS

to ensure the sustainability of core GP services and access arrangements that meet the reasonable needs of local patients)

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

Using the principles of federating practices to support primary care on the island

The health and sustainability of practices are under threat with rising demand, administrative requirements, recruitment issues, and costs.

To explore the option of federating the practices on the island To discuss what tasks and services would be best provided by a federated group rather than individual practices

Continue discussions at future Cluster meetings including attendance at the planned meeting on the principles of federations in primary care at Portmeirion on 26/1/17

Ongoing

IT Promote use of IT to improve patient care and system efficiencies in the community

To monitor progress in the projects listed by regular updates in Cluster meetings

(a) Full implementation of MHOL (b) Full implementation of primary care access to IT

information in secondary care including GPTR (c) Increased use of SMS Text messaging. (d) Clear outcomes from EMIS User Group and IT

development including shared templates (e) Introduction of EMIS and Vision Remote

Community platforms (tablets) to support work in Care Homes and the work of other professionals including Mon Enhanced Care and District Nurses.

(f) SPOA referrals to be made by WCCG

HW SM DapD CB SM

6 m 1 y Ongoing 1 y 6 m 6 m

DRAFT

2016 Version 0a 6

3rd Sector

Liaison

Patchy awareness of availability of 3rd Sector support in the community

3rd Sector Liaison Officer appointed January 2016 using Cluster Fund monies Seiriol Ward co-production project in place 18 months Support “social prescribing” on the island

Report from 3rd Sector Liaison Officer (Cymunedol Môn) on progress and outcomes of liaison work Presentation on outcomes from Seiriol Ward Alliance project and relevant learning for GP practices Enhance the current National Exercise Referrals Scheme to include other social and exercise based activities

LM SM SM

6 m 1 y 9 m

Faecal Calprotectin Test in primary care

GPs do not currently have access to Faecal Calprotectin Test. This is a useful test to help diagnose or exclude the diagnosis of inflammatory bowel disease. NICE guidelines and local hospital supports primary care access to this test.

Guidelines on local use of the test developed In partnership with the Arfon Cluster 500 tests purchased for primary care Hopefully appropriate use following the guideline will be proven and cost-effectiveness demonstrated allowing case to be made to mainstream provision of test to all GPs in BCUHB

Audit of the first 100 tests requested by Arfon and Anglesey GPs to be undertaken and presented at a Cluster meeting and to Area West management team

SM

6 m

DRAFT

2016 Version 0a 7

Wylfa and other commercial developments on the island population

A number of developments are being planned for Anglesey including Wylfa B nuclear power station, Land and Lakes tourist destination, and Lorry Terminal It is predicted that this could result in as many as 11000 workers and their families moving onto the island This will have an implication for provision of community care on the island including workforce and premises issues

To assure regular dialogue with developers, PHW, BCUHB/Area Team and other agencies to ensure community services supported with this predicted increase in population

Continue current series of meetings involving relevant GP practices, West Area Management Team, developers, LA, and other stakeholders.

WT Ongoing

48 hour Ambulatory ECG (AECG) Service in the community

Currently long waits for patients to have ambulatory ECG (AECG) investigations in secondary care

To enable GP Practices to have direct access to AECG recording for their patients

4 AECG machines leased from Cardionetics and put into several GP practices. Guidelines for use done. Self reporting software installed. Audit of use and outcomes to be undertaken at end of 12m use. Training session to be arranged with local cardiology specialist

SM SM

18/10/16 18/10/16

DRAFT

2016 Version 0a 8

WORKFORCE

Important Note: Each Practice has submitted practice specific plans to detail what will be done in order to meet any practice specific workforce needs e.g to cover a period of maternity leave, recruit to a specific vacancy. The table below refers to matters that can be taken forward at a Cluster level and/or require HB input.

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

Recruitment in General Practice

Reduced availability of trained GPs to fill vacancies in practices. Potentially this could get worse over the next few years with expected GP retirements. Small pool of available GP locums. Increasing workload in primary care and fairly static GP numbers

To improve GP recruitment in BCUHB with particular reference to Anglesey

To attend RCGP Annual Conference in Harrogate and promote General Practice in North Wales on exhibition stand there List all practices willing to provide work experience to school children on the island

SM HW

8/10/16 1 month

DRAFT

2016 Version 0a 9

Practice Nurse and Community Nurse Development

Need to develop highly trained primary care and community nursing workforce including health care support workers (HCSW), practice nurses with specialist skills, community nurses with specialist skills, and ANPs including prescribing Nurse Practitioners Loss of ANPs would be detrimental. Employment of more ANPs would be beneficial.

To promote practice nursing and health care support working as a career locally and provide high quality training for all levels. Retention of ANPs by enhancing their portfolio and training Continue use of Cluster Fund to support nurse and HCSW education

Learn from feedback and improve the monthly Nurse and HCSW evening education programme at YG Ensure success of 2 year Practice Nurse course starting September 2016 at School of Nursing, Bangor Support primary care professionals mentoring nurses undertaking ANP training for the benefit of the Cluster through Cluster Funds Use of Cluster Fund to support practice education / development by providing agreed budget for each practice

SM/KR SM/KR SM WT

3 m 6 m 3 m Ongoing

Community Nursing

There seems to be an increasing workload for District Nurses coinciding with a reduction in numbers of District Nurses on the island. Increasing workload partly due to drive to look after people in their own homes, earlier discharge from hospitals, and ageing population

To support the development of the community nursing teams on the island

Regular updates at Cluster meetings from Locality Matron on the development of community nursing Evaluation of Co-location and whether it adds value.

SO SJ IR

Ongoing 6 m

DRAFT

2016 Version 0a 10

Development of management and reception teams in primary care

No clear education structure for Practice Managers and other staff

To develop a clear education plan to support Practice Managers and other staff in their work

Continue discussions at future Cluster meetings including attendance at the planned meeting on the principles of federations in primary care at Portmeirion on 26/1/17 PET Sessions; Specific content to be developed for practice management and support staff EMIS and Vision development and sharing of good practice between practices. Use of Cluster Fund to support practice education / development by providing agreed budget for each practice

SM DapD WT

Ongoing 12 m Ongoing Ongoing

Advanced Musculoskeletal Physiotherapist Practitioner

Increasing workload in primary care. Concerns about GP recruitment and practice sustainability. Desire to bring services out of secondary care into the community and closer to the patient. To increase skill mix in primary care Musculoskeletal problems are very common in the population.

To employ Advanced Musculoskeletal Physiotherapist Practitioner to undertake sessions in practices on the island. The post-holder will see patients presenting with musculoskeletal symptoms and undertake full assessment, investigations as necessary, and provide treatment including joint injections. It is intended that the post-holder will see patients who would have otherwise seen their GP after the patient’s request has been triaged by the reception team.

Following discussion with practices at Cluster meeting 8 practices expressed interest and the Cluster agreed to employ 1.5 WTE physiotherapy sessions across the Cluster. Therapies involved in discussion and happy to provide sessions. Suitable physiotherapists to be interviewed and trained as needed. Audit of impact of service including numbers of the following: patients seen, unused appointments, patients referred after seeing GP first, patients needing to see GP again after seeing physiotherapist, investigations undertaken, and joint injections undertaken. Also will audit clinical outcomes and physiotherapist, practice, and patient satisfaction. To present audit to Cluster after 6 months of service.

RC/SM RC/SM

6 m 12 m

DRAFT

2016 Version 0a 11

Specialist Practice Pharmacist

Increasing workload in primary care. Concerns about GP and Practice Nurse recruitment and practice sustainability. To increase skill mix in primary care Audits of hypertension management in primary care suggests that blood pressure control could be improved

To employ specialist pharmacist with special interest in management of hypertension in practices in the Cluster. The pharmacist will particularly look at patients whose blood pressure has proved difficult to control to see if additional patient education and adjustments to medication helps improve it.

Following discussion with practices at Cluster meeting 3 practices expressed interest and the Cluster agreed to employ 0.5 WTE specialist pharmacist sessions across the Cluster. Area West Medicines Management Team involved in discussion and happy to provide sessions. Suitable pharmacist(s) to be interviewed and trained as needed. Audit of impact of service including numbers of patients seen, numbers of unused appointments, numbers of patients referred by GP and PN, BP control, adverse incidents, patient, pharmacist, and practice satisfaction.

AH/SM AH/SM

3 m 12 m

Care Home COTE GP

Care Home work is extremely important looking after an increasingly frail elderly population with complex needs. There are 800 patients in Care Homes on Anglesey. There are a significant number of admissions to hospital from Care Homes some of which could have been prevented

To employ an experienced GP under the Care of the Elderly Team to undertake Care Home work on the island. The post-holder’s work will include supporting GP practices with a high Care Home workload and introducing Advanced Care Planning

Interview took place on 23rd September. Excellent GP appointed. To commence induction period on 10th October. Working 3 days a week school terms until next summer. Outcome measurements to include number of patients seen, number of Care Home staff education sessions undertaken, admission statistics from Care Homes to Ysbyty Gwynedd, number of Advanced Care Plans including Treatment Escalation Plans put in place, and number of homes visited.

SM JW

1 m 9 m

DRAFT

2016 Version 0a 12

REFERRAL MANAGEMENT AND CARE PATHWAYS

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

Complex patients including those with several co-morbidities

With the current workload and available workforce it is difficult for practices to give enough time to patients with “complex” problems Practices would benefit from education and support in looking after patients with multiple comorbidities

Encourage development of specialist services in the community closer to GP practices Support specialist nurse mentoring of Practice Nurses and GPs looking after these patients

Continued development of Diabetic Service on island started in October 2015. Objectives include: - Targeting patients with high HbA1c,

polypharmacy, or risk of hypo’s - Xpert training / structured education - Insulin initiation - Joint clinics - e-learning - National diabetes audit at practice level Service to report progress at a Cluster meeting Introduction of Atrial Fibrillation Service in practices with appointment of specialist pharmacist by the cardiac network. This will particularly support practices with decision making around anticoagulation.

DH

GT/SM

6 m

6 m

Dementia Training in recognition, assessment, and management for primary care team

Provision of specific dementia training to practices Development of dementia services on island

Provide directory of educational resources for practices on dementia topics Practices to take part in Dementia RED programme. Record % taking part. LLT members to attend Cluster meetings to update Locality developments Report from 3rd Sector Liaison Officer (Cymunedol Môn) on progress and outcomes

BW SM SJ IR LM

1 y 1 y 6 m 6 m

DRAFT

2016 Version 0a 13

Primary Care - Secondary Care interface

Improved communication and pathways between primary and secondary care very important on many levels including quality of care and patient safety

Continue primary care - secondary care meeting programme in Protected Education Time sessions Monthly Ynys Mon Medical Society Meetings programme to continue. Set up a Cluster working group looking at specific issues concerning the interface between primary and secondary care

SM SM SM

Ongoing Ongoing 6 m

Medical photography

It is helpful for the dermatology team to receive a photograph of skin lesions when a patient is referred as a USC referral

Practices have all been supplied with a camera and have been asked to attach a photograph when making a USC dermatology referral via WCCG

Audit use of camera and feedback from GPs and dermatology team

AM

6 m

Abnormal liver function tests investigation and management pathway

It became apparent at a Ynys Mon Medical Society meeting that primary care knowledge of the investigation and management of abnormal liver function tests is patchy

A pathway has been developed by the Benllech practice and circulated to all practices.

Monitor use of the pathway and make changes to it in response to feedback or new guidelines

SM

1 y

DRAFT

2016 Version 0a 14

UNSCHEDULED CARE (To provide high quality, consistent care for patients presenting with urgent care needs and to support the continuous development of services to improve patient experience, co-ordination of care ad effectiveness of risk management)

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

Supporting provision of Near Patient Testing (NPT) in practices

Some tests can be used more effectively if result available without delay

To trial the use of a CRP NPT machine in primary care Quick access to CRP result will inform patient care including appropriate use of antibiotics

CRP NPT equipment provided in one GP surgery from November 2015 to see if it aids management decisions and allows better informed prescribing of antibiotics. Assessment of use has shown significant drop in antibiotic prescribing in that practice since then. Also noted that positive feedback from GPs and patients on the provision of the CRP NPT. To purchase additional CRP NPT equipment for 4 other practices on the island and record impact in the same way to see if antibiotic use reduced. In addition to introduce antibiotic audit to practices not using CRP NPT to see if audit process reduces antibiotic prescribing

AH SM

3 m 3 m

Suicide Prevention GPs and primary care teams feel uncertain as to how to assess suicide risk and support patients at risk. Significant public health issue Current lack of capacity in mental health services

Suicide Prevention Training took place on 22nd September. Reasonable attendance by Anglesey GPs.

Following the training on 22/9/16 the plan is to facilitate Suicide Awareness and Patient Support Plan software to be uploaded on to practice computer systems as clinical aid. It is hoped that the software will be available in January 2017.

SM

Jan/Feb 2017

DRAFT

2016 Version 0a 15

AKI Acute Kidney Injury is a significant cause of unscheduled admissions

To provide information to patients on how to avoid AKI

Circulate software to practices embedding issuing of AKI leaflet in computer system

DapD

6 m

Development of Enhanced Care Service / Mon Enhanced Care (MEC) I.V. Therapy provision Support of housebound patients with chronic disease such as COPD

Availability of nursing and social care support out of usual hours

Services to be developed more to provide more comprehensive 24 hour 7 day a week service Difficulty recruiting nursing professionals to take part in MEC Needs proper staffing and resourcing and further integration with district nursing teams

To support development of effective Enhanced Care Service (MEC) on the island To support provision of IV therapy in the community To support the development of user friendly referral documentation using appropriate e-referral system

Regular meetings with Locality Matron and MEC Team including COTE consultant to discuss issues. Support community nursing developments. Model Mon LLT members to attend Cluster meetings to update Locality developments including use of ICF monies Additional GP/COTE doctor has been in post now since July. This means that MEC now have much better doctor support than a year ago. Plans to expand role of MEC continue to be discussed in regular MEC meetings.

SM SJ IR SJ IR SM

Ongoing Ongoing Ongoing

Advanced Care Planning

Unfortunately some patients are admitted to hospital as an emergency when it isn’t in their best interest

To promote advanced care plans on the island particularly in Care Homes

Introduction of Treatment Escalation Plans (TEPs) in Care Homes across the island through education of GPs, use of ANPs, and support of COTE team including newly appointed GP/COTE Care Home doctor

SM

12 m

Flu immunisation programme

Flu immunisation is important in prevention of unscheduled admissions Uptake of flu vaccinations below BCUHB average on island

To promote flu immunisation on the island To clarify role of community pharmacists

Presentation and discussion at Cluster meeting by PHW. Learning also from other practices. Support from Medicines Management Team regarding role of community pharmacists.

PHW SM

Sept 2016 - ongoing

DRAFT

2016 Version 0a 16

TARGETING THE PREVENTION AND EARLY DETECTION OF CANCERS (Refer to National Priority Areas CND 006W)

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

Referral of patients to other practices in the Locality for specific services

Some practices undertake specific procedures relevant to early detection of cancer that might be a useful referral option for other practices. Examples include sigmoidoscopy, dermatoscopy, minor surgery and indirect laryngoscopy.

Explore option of referrals from GP Practice to GP Practice for specific services

Discussion of federation model and sharing of services Attendance of practices at Federation Conference in Portmeirion on 26/1/17

SM 1 y

Early detection of

cancer and

appropriate USC

referrals

Early detection of cancer

is very important but often

difficult

To educate GPs and

other health

professionals in

locality on how to use

scoring systems such

as Qcancer

Clarify local referral,

investigation, and

management

pathways in different

specialities

Continue primary care - secondary care meeting programme in Protected Education Time sessions To continue monthly evening education meetings through the Ynys Mon Medical Society Clinicians to complete individual case reports for patients newly diagnosed with lung, digestive system and Ovarian cancers via the Significant Event Analyses Templates (SEA) 2015/16 To complete the exercise as laid out in requirements for cluster domain in QOF 2015/16. Results of this to be discussed at Cluster meeting

SM SM SM

Ongoing Ongoing March 2017

DRAFT

2016 Version 0a 17

IMPROVING THE DELIVERY OF END OF LIFE CARE (Refer to National Priority Areas CND 007W)

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

DNA CPR forms Advanced Decision Making

Confusion in relation to DNA CPR status within various settings – i.e. hospital , care homes and OOH - particularly when patient transferred Need to discuss end of life issues more with patients and their families

Everyone looking after a patient should be clear as to whether a DNACPR form is in place and when it was last discussed with the patient and family Promote Advanced Care Planning to our patients and families To support the Treatment Escalation Plan (TEP) pilot as a Cluster and support wider implementation

Continue palliative care input into Cluster meetings. Attending meeting in December. Introduction of Treatment Escalation Plans (TEPs) in Care Homes across the island through education of GPs, use of ANPs, and support of COTE team. Continue development of Palliative Care Templates with correct READ Codes etc on Practice Computer systems with support of EMIS Users group and Vision.

SM SM DapD

Ongoing 12 m 6 m

Palliative Care Education

Education for primary care professionals and Care Homes is important to improve palliative care in the community

Provide good quality education locally

Arrange palliative care educational sessions through discussions with palliative care team. PET educational meeting arranged for Tuesday 8th November and Wednesday 15th February.

SM

DRAFT

2016 Version 0a 18

MINIMISING THE HARMS OF POLYPHARMACY (Refer to National Priority Areas CND 008W)

Priority The issues Aims and objectives

How will this be done? Named Lead

Time Scale

Polypharmacy in the

frail elderly

Polypharmacy risks in the elderly.

To reduce risks in this patient group

“No-Tears” Reviews in Practices and sharing of lessons learnt.

SM

9 m

DRAFT

2016 Version 0a 19

PREMISES PLAN

Important Note: Each Practice has submitted practice specific plans to detail what will be done in order to meet any practice specific needs relating to premises. The table below refers to matters that can be taken forward at a Cluster level and/or require HB input.

Issue Why? What will be done at Cluster Level

How will this be done? (Practice; GP Cluster; Health Board) Named Lead

Time Scale

Capacity within current buildings including car parking

Not enough room for existing services Other agencies using rooms within the building Practices keen to house more members of the Patch MDT if only they had room Practices keen to develop services Difficult to increase training capacity on the island

Link budget for spatial development to commitment to training or development of specific services Liaise with Local Authority Liaise with BCUHB

Options suggested by clusters are:

1. New Primary Care building to be built on the Ysbyty Penrhos Stanley site to incorporate all 3 Holyhead Practices

2. New Primary Care building In Llangefni incorporating both practices.

3. Beaumaris Health Centre: Extension to provide more space for MDT working and new services. Alterations to Reception area to improve patient confidentiality.

4. Bodorgan, Llanfaelog, and Gaerwen: Working to full capacity and all 3 buildings would benefit from an extension.

5. Cemaes Surgery: Creation of additional room for HCA.

6. Coed Y Glyn: Funding for an extension if unable to proceed with new building in Llangefni (see 2. above)

7. Dwyran: Disabled access needs improving. Additional space / extension required for dispensing team.

8. Gwalchmai: Insufficient storage space for records: alternative storage options to be explored.

9. Llanfairpwll Health Centre: Significant lack of space both in building and in car park. HB owned building. Plenty of space to develop around the building. Significant extension needed to fully develop services and MDT working.

10. Star: Needs grant to improve disabled access

SM

WT

3 y

DRAFT

2016 Version 0a 20

MPIG Changes Potential closure of branch surgeries Loss of staff due to costs

Funding pressures in line with loss of MPIG Plans to close Transport problems for patient (in the event of branches closing)

Identify cost implications in relation to loss of MPIG.

Discussion with PCSU, BCUHB, GMC and WG through LMC EapI RK

Ongoing

Some practices are concerned regarding lack of confidentiality in their reception areas

Open plan reception areas causing concern

Sharing of

experiences of

different

reception area

design

Liaise with BCUHB regarding improvement grants (see premises plan above)

PMs group

1 y

Disabled Access Some practice buildings are not disabled compliant including facilities for deaf

Map problems

regarding

disabled

access

Discuss with BCUHB Estates Enquire regarding grants for specific equipment options to help patients with deafness access services

PMs group

3 y

DRAFT

2016 Version 0a 21

CLUSTER NETWORK ISSUES

Issue Why? What will be done?

How will this be done? (Practice; GP Cluster; Health Board) Named Lead

Time Scale

DRAFT

2016 Version 0a 22

LHB Issues

(in addition to any issues raised above requiring Health Board input)

Issue Why? What will be done?

How will this be done? (Practice; GP Cluster; Health Board) Named Lead

Time Scale

Paperwork Too much paperwork for primary care

Reduce unnecessary paperwork

PCSU/HB review of paperwork that Practices have to complete “Paper!” to be produced on how this can be addressed

PCSU PMs

3 y

Welsh Language What support is available for practices?

Review current support and identify unmet needs

Discussion between BCUHB, Cluster, LA, and 3rd Sector SM 3 y

Changing practice list sizes

Some practices feel under threat because of dropping list sizes, threatened closure branch surgeries and others are concerned regarding big influx of patients due to local developments such as Wylfa

Formation of clear strategy for the island regarding primary care provision and support of General Practice

Meetings between GP Practices and PCSU/BCUHB/Estates SM PMs WT

18 m

Information on BCUHB Intranet

Often difficult for primary care to access information on the BCUHB Intranet

Discussion between primary care and BCUHB on what needs to be developed

Issues to address include one clear point of access to all referral pathways SM 1 y

DRAFT

2016 Version 0a 23

LHB Issues

(in addition to any issues raised above requiring Health Board input)

Issue Why? What will be done?

How will this be done? (Practice; GP Cluster; Health Board) Named Lead

Time Scale

Specific Service Improvements in the community

There is documented concern about deterioration in provision of a number of services in the community affecting patient care

Discussion with BCUHB regarding concerns raised by GP Practices

Areas of concern include the following: Stroke Services in the community Physiotherapy Services in the community Speech Therapy Services Dementia Services particularly Day Care provision Mental Health Services particularly lack of substantive consultant psychiatry post on Anglesey Need for more Care of the Elderly specialist support in the community Better access to DAPHNE in the West Better access to dietetic services for patients with low BMI Pulmonary Rehabilitation Services Availability of equipment such as hip protectors

Ongoing

Continuing Health Care Funding

CHC Funding applications bureaucratic and time-consuming

Streamline application process? Leave responsibility in hands of Patch MDT? Nominal budgets for Cluster or Patch MDT?

Discussion at BCUHB level Steve 3 years