1. Healthy Prestatyn/Rhuddlan Iach

2. 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

3. 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

4. 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?

5. Opportunity
Better model
Better chance of sustainable workforce

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

7. 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

8. 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

9. 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, and Skype.

10. 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

11. 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

12. 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

13. 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.

14. 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?

15. Challenges Changing Patient behaviours
Changing Professional behaviours
Challenge behaviours

16. Any Questions ?