There are four practices which operate in the Cardiff East Cluster area
We have prioritised bowel screening. By increasing the information, marketing and priority of bowel screening we have increased its uptake in Cardiff East.
We also identified that our patients were finding it difficult to access pulmonary rehabilitation so we set up a local community pulmonary rehabilitation course which has run successfully in Rumney Medical Centre, 3 times in the past 18 months.
Early in the gestation of Cardiff East Cluster we set our clinical priorities as Diabetes, Heart failure and Dementia. We have set up local enhanced reviews (by their GP) for patients with Dementia and Heart failure. These patients have a nominated GP with faster access and continuity to that GP. The GP also ensures that the patient has optimised their medical management. The clinical and administration staff have had education sessions on diabetes, heart failure and particularly dementia. We have also run dementia specific information afternoons in the practices where we have had stalls in the surgery run by colleagues from Memory Clinic, Alzheimer's society, Care and Repair and Citizens Advice.
We work closely with the third sector, particularly Communities First. This includes:-
inviting patients for advice from Care and Repair on their 75th birthday
issuing patients with dementia a patient information pack from the Alzheimer's Society
social prescription offering referral to exercise classes, gardening groups, Men's Shed groups
setting up a more local MEND group addressing childhood obesity
We are also in the process of setting up a community cardiology clinic.
The Cluster felt that we needed to try and empower patients to look after their health more and have funded "health pods" in the practices. These pods enable patients to pop in without an appointment and measure their own blood pressure, height and weight. This helps them monitor their health and helps the GP record their on-going blood pressure. We have also funded 24 hour blood pressure machines in each practice.
Cluster lead update 13/09/2021