1. Corporate slide master With guidelines for corporate presentations Dr Richard Lewis, National Professional Lead for Primary Care Early Reflections on Clusters in Wales & Emerging Primary Care Quality Initiatives

2. The Wales We Want

3. Prudent Health Care “Prudent healthcare has to be about thinking differently about the services we provide and the relationship between the professional and the individual” 4 Principles: Patients and Professionals Equal Partners Greatest Health Need First Do Only What’s Needed, Do No Harm Reduce Inappropriate Variation, Evidence Based www.prudenthealthcare.org.uk

4. The Primary Care Delivery Plan

5. Children to be given the best start in life from very early years Thriving communities built on a strong sense of place Valuing our environment Investing in growing our local economy Reducing inequality and a greater value on diversity A stronger citizen voice and active participation in decision making Celebrating success, valuing our heritage, culture and language

6. NHS Wales Outcomes and Delivery Framework

7. QOF in Wales 2014-2017 Removal of QOF clinical indicators –2014-15 300 points –2015-17 102 points Creation of the Cluster Network Development Domain Support for the use of Clinical Governance Practice Self Assessment Toolkit http://howis.wales.nhs.uk/sitesplus/888/page/37945 Introduction of National Clinical Priorities

8. Clinical Governance Practice Self Assessment Tool (CGPSAT) Maturity matrix- 5 levels http://www.wales.nhs.uk/sitesplus/888/page/44038#A Based on the Welsh Health and Care Standards ‘encourages practices to bridge the gap between understanding and thinking about their governance systems and completing the actions needed to improve them’

9. National Clinical Priorities: GP Contract End of life care Frailty and polypharmacy Prevention and early diagnosis of cancer Lung Gastrointestinal Ovarian

10. Partnership with Public Health

11. Review cases arising January to December Individual case reports Reflect Summarise themes Identify actions Practice Summary Report Cluster discussion Agree priorities and actions Cluster Annual Report Personal development plan Practice Development plan Cluster Action Plan Health Board Plan Delivery Metrics to be developed

12. Example : Cancer Diagnosis and Care Emerging themes: Adopted Actions Importance of safety netting Need to actively manage care pathways/vulnerable groups Screening- understand/ reasons for failure to attend Ensure correct interpretation of negative investigations Continuity in GP to recognise frequent attendance – possible serious underlying concerns Need for more systematic use of adverse incident reports Better access to diagnostics Lower threshold of suspicion More discriminating about diagnostic tests Vigilant follow up of results Proactive about screening Active response to downgrading Actively engaging with CPD Case based discussions in practice More systematic approach to weight, smoking status etc Engagement to improve clinical pathways

13. Blaise Pascal (1623-1662) “ People are generally better persuaded by the reasons which they have themselves discovered than by those which have come in to the mind of others.”

14. Patient Safety Research

17. SAIL, PRISM & NDA Automated extract – external data transfer utility Automated aggregated data extract Automated software updates Central Repository GP Practice based tool Primary Care Aggregate Data Repository

18. Audit+ Modules, Projects and Patient Level Data Extractions Supported QOF 2015-16 Disease prevalence & incidence Data quality ‘Tidy Ups’ Diabetes DES DRSSW Retinopathy For Public Health Wales –Flu vaccination reporting –Pneumococcal vaccination reporting –Shingles vaccination reporting –Meningitis ACW&Y reporting –Pandemic Disease System –Post viral complications National Diabetes Audit HQIP Chronic Kidney Disease Audit National Chronic COPD Audit PRISM data extraction module SAIL data extraction module

19. Familial Hypercholesterolaemia module Coeliac Disease Audit NDA Practice Support Prescribing Safety Appointment System/Workload data extraction COPD Practice Support GMS Flu module Disease prevalence – co-morbidities Healthchecks+ –Support CHD, Diabetes & Stroke Delivery Groups joint initiative Audit+ Modules soon to be deployed

20. Primary Care GMS Flu

21. QUESTIONS?