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South Powys


Cluster Lead Dr Doug Paton

 

The South Cluster has a high level of maturity, with collaborative working very well embedded and partner participation consistent. National award for South Powys primary care cluster: Leading the way in cluster working in Wales (December 2019)

There are also 8 Pharmacists, 6 Optometry Practices, 8 Dental Practices and 2 Community Dental Services in the Cluster. It is comprised of 4 GP Practices with a population of 45,580.

GP Practices in South Powys 

Brecon Medical Group (Brecon and Sennybridge)
Ystradgynlais (Meddygfa Pengorof) 
Hay on Wye Health Centre (and Talgarth)
Crickhowell Health Centre 

Individual Cluster Plans and Reports   

South Powys IMTP 2020 - 2023 
South Powys Primary Care Cluster Yearbook November 2019 
South Powys Three Year GP Network Action Plan 2017-2020       

What we are working on?

The South Cluster has worked since 2012 to develop a primary care model that integrates primary/community care to provide better access for patients to high quality primary care services and to provide sustainability of these services by promoting new ways of working.

What we have already done

 The Cluster have implemented a large part of the All Wales Primary Care model:

Virtual Wards and Community Resource Teams

Introduction of telephone triage and remote working across all practices

Signposting to the most appropriate service for the presenting need by both receptionists and clinicians

GP with Special Interest delivering Dermatology service for the Cluster

Introduction of Health Board Silver Cloud online CBT system to support practices and community mental health services

Clinician triage for both planned and unscheduled care

New members of the primary care team – pharmacists, pharmacy technicians, ANPs, physiotherapists

Introduction of cluster based Pharmacist team to support GP practices and community services using Pacesetter funding

Use of Skype for medication review meetings cluster wide

Near patient testing

Optometrists – signposting of patients to service

Practice based muscular skeletal physiotherapists

Cluster wide enhanced services including minor surgery

Increased involvement of Third Sector – Red Cross, PURSH [Powys Urgent Response Service at Home], Macmillan, Credu

Introduction of 3rd Sector Community Connectors, attached to each practice to support statutory service providers, through partnership with PAVO

Recording of all calls within the practice for training and monitoring purposes

Remote ways of working for pharmacy and triage

Standardised template used by GPs for easy clinical outcome evaluation

Photos held on medical records to monitor healing rates with dermatology

EMIS system within the hospitals

My Health Online

Online booking for appointments and prescriptions

Active monitoring for mild to moderate mental health problems

Introduction of 3rd Sector MIND practitioners to support GP Practices and Community Mental Health Services using ICF funding

Social prescribing by MIND

Development of Community Interest group for the GP network – Red Kite – since 2015

  Future Priorities

Further work is required to develop the governance and assurance frameworks required to clarify accountability arrangements

Appropriate level representation from all partner organisations is a priority going forward

Limited capacity with partner organisations to plan and manage change

Organisational change and consistency of involvement

Converting short team funded developments into long term funded service changes

More direct influence into Executive Team