1. Integrated Locality-based Care
Elaine Lorton – Assistant Director of Primary Care / County Director – Pembrokeshire
Rhian Dawson – County Director - Ceredigion

2. Context of Primary Care in 2018
Start with what Primary care is and how it fits into the whole
What we see
What we do not see
How everything is intrinsically ALREADY linked together

3. Sustainability Challenges
43% of GP Practices have some level of recognised sustainability challenge
Welsh bit here
The root system is currently compromised
When struggling for survival it can stimulate innovation or quash it
Doing the same no longer works

4. What our population are saying
TCS – speaking to our communities – they know what they want

5. The Welsh Transformed Primary Care model
The work at an All Wales level is telling the same story...
whole system,
new ways of working,
new roles,
wellness, community resilience

6. One seamless system that is delivered at Locality level
Setting the Direction (2010)
Social Services & Well Being Act (2014)
Our plan for a primary care service for Wales up to March 2018 (2015)
Well-being of Future Generations Act (2015)
Parliamentary Review (2018)
One seamless system that is delivered at Locality level
Been on this path for some time – the Parliamentary review should not be a surprise...
WHY have we not done it then OR
Have we done a lot and not really recognised it
How to do we build on good practice, isolated innovation and ensure it can be equitably accessible but delivered based on local needs and variation?

7. Evolution of the Locality
Quality & Productivity
GP Cluster Network Domain
2015- present
Cluster Network Domain & Funding
Welsh bit here
We talk about Localities in Hywel Dda – not clusters
Purposefully about whole areas, the communities and services within it
BUT the contracts have diverted this vision and there is still much to do to stimulate greater Locality integration

8. Building Integration vs Stabilising the core
It can seem as though the path to building and developing Locality integration is at odds with stabilising the core BUT
Back to the tree image – everything is connected
Pacesetter HUB & NETWORKS project (get some facts - KI)
Current level of integration (get up to date facts - TH)
There is already a significant level of integration – wanted to give a couple of examples...

9. South Ceredigion - Frailty
1812 Pharmacist-led clinical interventions
1285 Nurse-led interventions
186 new MDT patients
160 follow up MDT patients
Figures for 2017/18
Frailty team of Locality funded ANP and Pharmacist – Locality funded
Cost savings using the Sheffield model – predicted / projections

11. South Pembrokeshire - OTs
Enabling people to maximise their own potential
Proactively resolve health and social issues at an early stage
Reduce demand on GPs
39 new referrals per month
85% seen within 48 hours
Most referrals following reduced function, falls of for holistic assessment

13. Llanelli – Social Prescribing
2 Social Prescribers
Spice Time Credits
6 Surgeries
550+ referrals

15. Challenges to overcome together
Building on good practice we did not invent
Trusting different professional roles
Speaking the same language
Agreeing joint priorities
Aligning our resources for best whole system impact
Collaborating and not competing