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3 – Implementing action

Having decided on a course of action—perhaps informed by an outline business case—the case for change may need refining/ updating to reflect more detailed operational planning considerations as these emerge. Project plans will need clearly-articulated ambitions, ongoing active management, identification of funding and workforce requirements, and sense-checking against population health thinking.

SMART outcomes and logic models
Outcomes describe what we are trying to achieve (for service users or others) by doing the activity; they are not the same as outputs—the things we produce (such as a report) in the process of carrying out the activity. It may help to think of outcomes as aims, and of outputs as project objectives or products:

  • Outcomes should ideally be SMART (specific; measurable; achievable; realistic; time-bound). In addition, don’t forget to describe the desirable patient/ service user experience.
  • Logic models (see section 4) can help sense-check the elements that must come together to successfully plan, deliver and evaluate a project—providing clarity on intended outcomes.

Project management
Project management can be defined as “the discipline of applying specific processes and principles to initiate, plan, execute and manage the way that new initiatives or changes are implemented within an organization” (Axelos). A project is a “temporary venture that exists to produce a defined outcome” (Axelos) that requires initiation, planning, execution/ delivery, monitoring (see also section 4), and closing down. Various methodologies and templates exist to support each of these stages:

  • Cluster project planning: Cluster Governance: A Guide to Good Practice covers starting up; business cases; project boards/ steering groups; project manager role; project initiation; expertise recruitment; project plans; recording and monitoring; reporting and accountability; and evaluation (Appendix 12).
  • The Cluster Governance: A Guide to Good Practice also provides templates for project proposal; goal-directed plans; action plans; risk management; highlight reporting; general reporting (SBAR); and for post-project review and summary.
  • Resources to help you develop your cluster: Includes a collection of project management resources (part of Cluster working in Wales)
  • PRINCE2® glossary of terms: Project management terminology from Axelos, who provide PRINCE2 certification.
  • See also “Developing a business case” in section 2d above (a business case is part of the project management toolkit).

See also ACD Toolkit  which provides project management templates.

Funding sources
Funding available to support cluster-based initiatives may come from a variety of sources, encompassing one or more of the following:

  • Cluster funding
  • Prescribing incentive scheme
  • Integrated Care Fund (ICF)
  • Transformation Fund
  • Mainstream (core health board) funding
  • Strategic Programme for Primary Care Fund (replaces Pacesetter funding from April 2022)
  • Research funding (e.g. via Health and Care Research Wales; PRIME Centre Wales; NIHR to support robust service evaluation/ academic publication)

Financial stipulations and support
Clusters will need to be mindful of the need to comply with legal requirements and demonstrate due diligence with regard to procurement processes:

Workforce planning and support
Consult the following guidance, templates, and workforce sustainability tools:

  • Primary care cluster workforce planning (HEIW): The step-by-step approach to workforce planning in primary care provides a simplified methodology for practices and clusters to use to create their workforce plans.
  • Primary care roles in Wales (PHW): Signposting links to various resources, including the Compendium of emerging roles and models in primary care (here).
  • Primary care clusters: staff recruitment and training: Cluster Governance: A Guide to Good Practice covers values and behaviours; recruitment to cluster teams; workforce planning; education and training of cluster staff; and professional support and supervision (Chapter 11).
  • The Cluster Governance: A Guide to Good Practice provides sample job descriptions for cluster lead, practice manager, cluster co-ordinator, and project support officer; it also provides a protocol for staff employed by the local health board working in GP practices and a template for a knowledge, skills and training survey.
  • Resources to help you develop your cluster: Includes a section on workforce planning (part of Cluster working in Wales)
  • Primary and Community Care Allied Health Professions (AHP) Workforce Guidance: Organising principles to optimise utilisation: This paper by the Strategic Programme for Primary Care is a call to action for the whole health and social care system to implement the recommended organising principles required to optimise utilisation of the AHP workforce in primary and community care. Also available in short read format.
  • All Wales Locum Register: The first point of contact for practices to identify Locum GPs registered on the All Wales Locum Register, Medical Performers List and ensuring that locum GPs benefit from the Scheme for General Medical Practice Indemnity.
  • Wales National Workforce Reporting System (WNWRS): A primary care workforce tool providing necessary identification of all GPs and health professionals employed in GP practices to be covered by General Medical Practice Indemnity and enabling greater workforce planning.
  • GP Wales: A single point to advertise and monitor permanent and locum GP vacancies (incorporating Locum Hub Wales).

Capital and estates planning
Any queries regarding estates and accommodation should in the first instance be directed to the Estates Team within the appropriate health board or local authority.

Welsh Government funding for health and social care premises is accessible via the Health and Social Care Integration and Rebalancing Capital Fund (IRCF):

  • IRCF was established to support a coherent approach to planning the co-location and integration of health (primary care) and social care services within the community across Wales, and to support the rebalancing of residential care provision by increasing delivery from within the not-for-profit sector.
  • Applications for the IRCF should be made via the RPBs and must contribute towards delivery of the relevant RPB Strategic Capital Plan.
  • Contact should be made with the relevant RPB to discuss any potential application for funding under the IRCF.

Population health perspectives
The PACE checklist reflects the values that public health specialists aspire to bring to conversations about how services could be reconfigured to best effect. It doesn’t have to be applied systematically, but could serve as a mental prompt to help clusters sense-check emerging plans against population health thinking:

PACE: A population health perspective checklist for cluster planning