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
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.
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
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
Cluster lead update 13/09/2021