Agenda item

To receive a verbal update from representatives from the Betsi Cadwaladr University Health Board on the Healthy Prestatyn initiative

11.40a.m. – 12.15p.m.

The Health Board’s Assistant Area Director of Primary Care and Commissioning briefed the Committee on the background to the establishment of the Healthy Prestatyn Iach initiative.  During her introduction she advised that:

·         General Practitioner (GP) practices were private entities, they ranged in patient caseload size.  The smallest GP practice in Denbighshire had circa 2K patients registered with it, whilst the average GP practice size in the county had in the region of 7K patients;

·                     the Healthy Prestatyn Iach model, which served patients registered with surgeries in Prestatyn, Rhuddlan, Meliden and Ffynnongroyw was a new way of delivering primary medical care, intervention and well-being, which was managed directly  by the Health Board.  It comprised of four teams within the surgery which dealt with the management of chronic cases, a fifth team which undertook home visits along with another team that delivered acute medical services for patients using the walk-in service;

·                     the Health Board managed service had been established to deliver primary medical care services in the area following a number of GPs in the area notifying the Board that they would be retiring or terminating their contracts for delivering GP services.  In establishing this innovative new model for delivering primary services the Board had also incorporated into the new model a more holistic approach towards the delivery of primary medical services and the general well-being of the population;

·                     the Service currently received was contacted by the public circa 100K a year, dealt with an average of 420 patients a day of whom around a 100 were seen on the day of contact.  The number of patients seen on a daily basis exceed the daily average for the Emergency Department (ED) at Ysbyty Glan Clwyd; 

·                     the Tŷ Nant facility, which the Health Board rented from the Council was a fantastic facility which supported the service-delivery model well;

·                     a new patient IT system had recently been installed which was working well:

·                     Health Inspectorate Wales (HIW) had inspected the Healthy Prestatyn Iach service during 2017 and had concluded that it was overall providing safe and effective care;

·                     there were challenges ahead, particularly in relation to the recruitment of clinical staff, training provision to the private provider sector and a continual increase in the demand on its services.  Between January and March 2018 there had been an increase of 6% in appointments and a 15% increase  in home visits undertaken by the service;

·                     moving forward the focus would be on recruiting an additional GP and an advanced nurse practitioner.  It was pleasing that a GP had indicated an interest in joining the service and that a nurse was currently training to qualify as an advanced nurse practitioner.  The Service was also planning to recruit a paramedic to complement the range of services it could offer and to appoint a Head of Service Manager – an operational manager to co-ordinate the work and back office functions for all sites operating under the auspices of Healthy Prestatyn Iach;

·                     the establishment of this innovative service had been a learning journey, particularly in relation to the different demands on the Service when delivering primary and secondary care.  Consideration was currently being given to linking into a study being undertaken by Bangor University on training and mentoring requirements for delivering primary care;

·                     the Health Board acknowledged that more work was needed with the third sector in the Prestatyn area in relation to understanding the types of services required in the area and how public sector organisations such as the Health Board, the local authority and third sector partners could work effectively together to deliver these services in the community to enhance health and well-being, promote independence, mitigate against social isolation and consequently reduce the demand on primary intervention medical services.

Responding to members’ questions Health Board officials:

·                     confirmed that they did not envisage money being diverted from frontline primary care services to fund the Head of Service Manager post.  This was a much needed post that should help co-ordinate and streamline back office administration work and reduce duplication with a view to delivering seamless frontline services;

·                     acknowledged that whilst it would have been advantageous to have the Head of Service Manager in post earlier during the establishment of the Service, there were other more pressing deadlines and requirements to be met, including sufficient number of GPs and other medical staff in post to deal with patient caseload, work relating to bringing together 5 GP practices into 3 whilst also amalgamating administration and working practices to ensure that the new service met patients’ needs and was effective and efficient.   All this work was taking place against the backdrop on a national crisis in the National Health Service (NHS);

·                     advised that as this was a new model for delivering primary medical care services it involved some considerable amount of work to educate both staff and patients on how the model worked and that patients may not always need to see a GP, an appointment with another medical specialist e.g. nurse, physiotherapist etc. may be more appropriate and beneficial;

·                     confirmed that the Healthy Prestatyn Iach Service at present had a full complement of staff, apart from GP staff.  A recruitment exercise to fill vacant GP posts was currently underway.  GP shortages across the country were exacerbated by a change in GP working practices with an increasing number of GPs opting to work part-time, some for work life balance purposes whilst others wished to devote part of their time to secondary specialisms;

·                     informed the Committee that the Nurse Consultant post was a new post.  This individual would work at a higher level and therefore help ease the pressure on GPs;

·                     advised that whilst the British Medical Association (BMA) guidelines may suggest a GP to patient ratio of 3 GPs per 1,000 patients there was no GP practice in North Wales with 3 GPs to 1,000 patients.  Healthy Prestatyn Iach’s aim was 1 GP per 2,000 patient;

·                     confirmed that the Health Board was confident with the model in operation at Prestatyn.  It had been challenging to establish as they only had 6 months to set it up and get it ready to operate to serve 22K patients.  They acknowledged that they had underestimated the level of training and support required for staff transferring into a different service model setting.  These lessons had been learnt for similar projects in future;

·                     the Health Board was ambitious  for the Service’s future.  Securing the use of Tŷ Nant building had been key towards the future development and consolidation of the Service, as the upper levels of the building lent themselves well for the co-location of specialist teams which would improve communication and interaction between all care providers;

·                     confirmed that the Service operated a walk-in ‘same day service’ where a patient would not be turned away.  However, they would need to be prepared to wait, perhaps an extended period of time, dependent upon the urgency of their ailment to be seen by the relevant practitioner.  Bookable appointments were also available.  Consideration was currently being given to introducing a triage system;

·                     advised that as part of the holistic well-being approach being taken by the Healthy Prestatyn Iach initiative work was currently underway to review diabetes care.  The aim was to enhance the service to include educating patients which were prone or at risk of developing diabetes about the healthy options and choices available to them in a bid to avoid medical intervention at a later stage; and

·                     informed the Committee that the Health Board wanted to work with the Council’s Education Service to draw pupils’ attention to careers available to them locally within the health and care services.