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Primary Care Model for Wales

What is the Primary Care Model for Wales?

The Primary Care Model for Wales (PCMW) is a model for Primary and Community Care, developed as a whole system approach to sustainable and accessible local health and wellbeing care. Focusing on place-based care, care closer to home and multi-professional working. It describes how care will be delivered locally, now and in the future, as part of a whole-system approach to deliver A healthier Wales.

Clusters are at the heart of this model and, given the key principles that underpin ‘A Healthier Wales’ can be described as:

A cluster brings together all local services involved in health and care across a geographical area, typically serving a population between 25,000 and 100,000. Working as a cluster ensures care is better co-ordinated to promote the wellbeing of individuals and communities.

The 60 clusters in Wales are multi-professional, with representation from health, social care and third sector professionals, who are working together to identify the assets, needs and priorities of the communities that they serve. Designing and delivering services that are seamless, focused on prevention and meeting the needs of the local community.

The development of the Primary Care Model for Wales

The Primary Care Model for Wales (PCMW) has evolved and has been influenced by a number of publications and areas of work during the period 2015 to 2018. All of which have added to the direction and breadth of the changes in Primary and Community Care in Wales.

The PCMW transformed as a model for Primary and Community Care, developed as a whole system approach to sustainable and accessible local health and wellbeing care. In 2019, the narrative was updated and in 2021 the maturity matrix was developed to support articulation of the 13 outcomes with accompanying maturity descriptors.

To strengthen the progress of clusters towards the PCMW, the Strategic Programme for Primary Care (SPPC) developed the Accelerated Cluster Development (ACD) programme. ACD is fundamentally about a clear line of sight from the local front line health and care services through to the Regional Partnership Boards (RPB) in terms of understanding the needs of the local population and being able to translate such knowledge into meaningful strategic priorities at an RPB / County and Cluster level. 

The Primary Care Model for Wales outcomes

The Primary Care Model for Wales (PCMW) has 13 outcomes which describe the key areas that need to be in place to deliver seamless, place-based care that focuses on prevention. The outcomes have three levels of maturity (Foundation, Developing and Mature). As cluster working evolves, the system will move towards the mature level.

The Accelerated Cluster Development (ACD) programme focusing on delivering place-based care through Professional Collaboratives and Clusters. ACD has seven outcomes which describe the ways of working that will support progression towards the PCMW. ACD outcomes have been adopted and incorporated into the monitoring and evaluation plan for the PCMW.

One organisation or profession alone are unable to deliver the PCMW. Therefore, in order to meet the outcomes, we need a collective effort across the health and care system and a system that sees the population needs and priorities as everyone’s responsibility. 

 

 

Evaluation of the Primary Care Model for Wales

The monitoring and evaluation of Cluster working towards the Primary Care Model for Wales (PCMW) and Accelerated Cluster Development (ACD) contains three components:

1. Peer review process

2. Self-reflection tool

3. Key indicators

The PCMW and ACD maturity matrix sets out the standards and maturity criteria expected for demonstrating implementation progress against the PCMW and ACD outcomes. The matrix is used within the peer review and self-reflection process to demonstrate the progress of Cluster working.

Peer review

2022/23 saw the introduction of peer review for Clusters and involved each Health Board nominating a single Cluster to be engaged in the peer review process, both as a reviewer and reviewee. Each peer review discussion focused on two PCMW outcomes and one ACD outcome, allocated to ensure that all outcomes were reviewed in the scheduled discussions. Participants reported that the process was informative, and the review achieved the aim of sharing good practice. 

Peer review report 2023-24

Cluster self-reflection

Cluster self-reflection is one of the agreed methods to evaluate the progress of cluster working towards the Primary Care Model for Wales (PCMW) and Accelerated Cluster Development (ACD) and sits alongside cluster peer review and the PCMW key indicators (under development).

luster self-reflection is one of the agreed methods to evaluate the progress of cluster working towards the Primary Care Model for Wales (PCMW) and Accelerated Cluster Development (ACD) and sits alongside cluster peer review and the PCMW key indicators (under development).

Cluster self-reflection assesses the maturity of cluster working against the PCMW and ACD outcomes and captures insight into the system enabler and barriers that facilitate/ hinder cluster working in Wales.

Cluster Self-relfection report

The first cycle of cluster self-reflection was undertaken between April and May 2024, with the aim of providing a baseline of the maturity of cluster working, and to identify system barriers and enablers. 46 of the 60 clusters, submitted responses and a wide range of professional groups engaged in the process, providing confidence that the results are representative of the current situation for cluster working in Wales.

Headline findings include:

  • The majority of clusters rated themselves as either foundation or developing across all outcomes.
  • Five system barriers were identified by clusters including Funding, Engagement, Lack of clarity, Lack of time and Bureaucracy.
  • Funding was the most frequently cited barrier.
  • The barriers to cluster working were identified as having a negative impact on innovation, project development and implementation, a negative impact on staff morale and a negative impact on patients.
  • Clusters identified five system enablers including Ways of working, Interprofessional working relationships, Leadership, Engagement with stakeholders outside of the cluster and the Value of individuals.
  • Factors that could strengthen clusters included Increased autonomy to make decisions and manage finances, Reduced bureaucracy, Access to sustainable resources, Agreed and established ways of working and Strengthening the role of the cluster.

Next steps:

  • The insight gathered from cluster self-reflection has been used to develop a range of ‘opportunities for action’ aimed at strengthening cluster working, which will be taken forward during 2024/25.
  • The next cycle of cluster self-reflection will take place in April 2025.

 

Key Indicators

Work is being progressed to identify key indicators that can provide robust, reliant, and purposeful data to measure the maturity of Cluster working. This work is being progressed alongside the development of the Primary Care Metrics. It is proposed that key indicators will be introduced as the third element of the monitoring and evaluation of the PCMW and ACD in 2024/25.

 

Useful resources