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Cluster Governance 'A Guide to Good Practice'

The purpose of this Guide is to support the development of primary care clusters across Wales.

You can download the guide here : A guide to good practice

Governance can be defined as ensuring we are doing the right things, in the right way, for the right people, in a manner that upholds the values of our member organisations.

The Guide sets out the principles of good practice and is accompanied by:

  • An online collection of Appendices, accessible through hyperlinks within the document
  • A Resource Pack providing a range of toolkits and templates developed locally around Wales, based on cluster learning. These are accessible through hyperlinks in the Guide and also via the list below entitled ‘Resource Pack’
  • A suggested cluster governance maturity matrix for cluster self-assessment

The timing of this work has been important. Firstly, Directors of Primary Care wanted to avoid overwhelming clusters in their early days of development and to give clusters the space to develop at their own pace.  Secondly, Directors wanted the arrangements to be informed by learning, recognising that clusters are at different states of maturity.

We began preparatory work for the Guide in 2017 and held a workshop in February 2018 to draw together governance arrangements for optimally functioning clusters. This document draws on this learning and good practice across primary Care in Wales to date.

Importantly the Guide is intended to be enabling, not overly prescriptive, and designed to support each cluster’s individual development journey. It is a working document and will be periodically updated to reflect further learning.

Overview of Appendices

Nolan Principles 
Definition of Primary Care Clusters
FAQ Guide for Primary Care Clusters
Managing Conflicts of Interest
Cluster Decision Making
Cluster Risk Management
Primary Care Cluster Accountability
Collaborative Continuum (Dotterwieich 2006)
Option Appraisal for Cluster Model
Cluster Leadership Team
Population Needs Assessments
Project Planning
NHS Finance (Wales) Act
Support for Cluster Financial Arrangements
Cluster Business Cases
Service Level Agreements
Cluster Hosting Arrangements
Professional Indemnity
Clinical Supervision and Mentorship
ICT and Information Systems
Primary Care Cluster Quality Assurance Mechanisms

Communication and Engagement
Cluster Communication and Engagement Principles
Cluster Communication and Engagement Strategy
Communication and Engagement Goals
Communication and Engagement Channels and Approaches
Communication and Engagement with Service Users, Carers and the Public
Communication and Engagement with Cluster Staff
Channels and Approaches for Wider Stakeholder Communication and Engagement
Defining What Success Looks Like – Communication and Engagement
Cluster Communication and Engagement Delivery Plans - OASIS

Resource Pack

General Information                                                                                     

Components of Transformational Model for Primary and Community Care – Pack 2
Maturity Matrix for Clusters – Pack 3
Principles of Good Governance - The Health and Social Care Review – Pack 4


Cluster Development

Example of Cluster Vision and Mission – Pack 5
Key elements to consider when forming a Cluster – Pack 6
Sample Cluster Options Appraisal – Pack 7
Sample Cluster Voting System – Pack 8
Sample Cluster Terms of Reference – Pack 11
Sample Terms of Reference for Cluster Leadership Group – Pack 12
Social Enterprise Toolkit for clusters - Pack 40


Population Needs

Integrated All-Wales Primary Care Needs Assessment – Pack 14

Cluster Project Planning

Sample Project Decision - Making Framework – Pack 10

Sample Project Prioritisation Framework – Pack 13

Sample Decision-Tracker – Pack 19

Project Proposal Document – Pack 28

Primary Care Development Project Template – Pack 29

Goal Directed Plan Template – Pack 30

Project Action Plan Template – Pack 31

Sample Highlight Report Templates – Pack 32

Post Project Review – Pack 33

Impact Assessments

Integrated Impact Assessment – Pack 15

Equality Impact Assessment – Pack 16

Privacy Impact Assessment – Pack 17

Risk Assessments

Risk Management Guidance – Pack 9

Project Evaluation

Logic Models in Evaluation – Pack 27

Business Case Development

Sample SBAR Template – Pack 18

Business Case Template - Pack 26

Resource Shift Framework – Pack 34

Primary Care Project Initiation & Business Case Development Process – Pack 35

FAQ Guide to Procurement - Pack 41

Workforce Development

Sample Cluster Lead Role – Pack 20

Sample Cluster Practice Manager Role – Pack 21

Sample Cluster Support Manager – Pack 23

Sample Project Support Officer – Pack 24

Protocol for Staff Employed by Local Health Board working in GP Practices – Pack 36

Cluster Development - Knowledge, Skills and Training Survey – Pack 37

Information Governance

Data Sharing Agreement (DSA) – Pack 38

Communication and Engagement

Sample Cluster Communication and Engagement Strategy – Pack 39

Good Practice Examples

Examples of a Business Case:

Treatment Unit Business Case

Audiology Advanced Practitioners Business Case

Examples of an Evaluation:

Audiology Advanced Practitioners Evaluation 2017

Treatment Unit Evaluation

Mind in Vale Evaluation

Mind in Vale Therapies

Care Home ANP innovation 2017/18

Care Home ANP Evaluation

Example of business processes

Procurement - FAQ guide for primary care cluster leads

Example new models of working

Federation - North Ceredigion Federation innovation 2017/19

We would welcome any new contributions from your cluster to include in the resource pack or within the good practice examples to share across Wales. Please send any documents to