Healthy Prestatyn/Rhuddlan Iach

Context GP contract resignations in North Denbighshire affecting 23,000 patients Tipping point regarding two issues we knew needed fixing – the primary care model and the primary care workforce Those issues are interlinked, but not the same

Primary Care Model Becoming increasingly medicalised to address the needs of a population with chronic disease which could be better managed in less medicalised ways Contract structure for primary care sometimes encouraging this medicalisation and also discouraging some potential new recruits

Primary Care Workforce Lots of older GPs heading to retirement Not enough coming through to replace on a like for like basis ! But we knew the model wasn’t quite right. So did we want to replace GPs in exactly the same way?

Opportunity Better model Better chance of sustainable workforce

The Model Built upon a social model of primary care ‘Prudent Healthcare’ Needs based Interested in empowerment and co-production

The Structure A same day service for urgent same day problems 4 main KeyTeams coordinating and providing longterm care, each with a list of around 5500 pts A home care / domiciliary / advancing frailty team – the “5th KeyTeam” An Academy

Same Day Service Urgent Primary Care Problems (infections/minor illnesses which may require medical treatment) Sit and Wait Service available Monday to Friday 9am til 4pm Operating from 1 site only (2 main sites and 3 branch sites) Predominantly Nurse Practitioner led service with GP support

Planned Care All appointments with KeyTeam members can be booked Directly Service for patients with more long terms conditions who do not have urgent need A Key Team approach where the focus in on co-ordination and continuity of care Aim for proactive approach where ill health avoidance is a primary goal The focus at appointment booking is to take time streaming the patient to the right professional first time System enabled to allow wide array of innovative approaches for follow-up, including telephone, email and Skype.

The KeyTeam Approach Individual (traditional) GP-led ‘lists’ replaced by KeyTeams looking after more patients but with A KeyTeam coordinator Occupational Therapists Pharmacists Nurse Practitioners GP Around that are a number of other healthcare professionals

Occupational Therapists The KeyTeam Approach KT Coordinators Occupational Therapists Pharmacists GPs Nurse Practitioners Advanced NPs Physiotherapists Audiologist Research Nurse Mental Health Specialist Services Community Nursing The real opportunity is in terms of how the above professionals can now work in partnership with others to deliver a truly social primary care model

Type 2 Diabetes The traditional approach Raised blood sugar prompts referral to GP GP starts pt on medication Variable amounts of lifestyle Medication often escalated considerably The Healthy Prestatyn Approach Raised blood sugar prompts team discussion If patient very high risk may prompt early GP input Otherwise management led by OT to ensure lifestyle and wellness interventions maximised before medication

Domiciliary and Care Home KeyTeam This team will provides the majority of care to our care-home patients, providing greater continuity of care The team is staffed to ensure a service skilled in managing frailty. Will develop to include secondary care colleagues with a CoTE, Palliative Care, Dementia background and Local authority Social Services and third sector Ethos of this team will also ensure a robust focus upon anticipatory care and care planning. Key metrics will drive a proactive approach to Treatment Escalation Plans, Advance Directives, Difficult conversations etc, (where it is appropriate) and ensure that this information is appropriately and effectively shared with OOH, ED, and WAST.

The Academy Community Facing Social Prescribing / Demedicalised Healthcare resource for patients. Proactive facility for delivering a broad range of lifestyle and health promotion sessions Local Professional Facing Resource for professional education Multidisciplinary learning, including LA and 3rd sector colleagues Wider Professional Facing Quality Improvement, Research, Innovation and future Recruitment Quality assuring the model – what works, what needs changing?

Challenges Changing Patient behaviours Changing Professional behaviours Challenge behaviours

Any Questions ?