1. Primary Care & Choose Well
I am and a member of the Hywel Dda University Health Board Primary Care Team. I am here today to talk to you about what Primary Care is and how it links to Choose Well.
We have asked for a slot on the induction programme / event to promote the Choose Well message and explain what Primary Care is and the services that are available. As part of the promotion of Choose Well and Primary Care its important that we ensure that staff within the Health Board are included as you are all users of health services as well as employees.

2. Aim of the Session Explain what Primary Care services are
Give an overview of the Choose Well message
Provide information about Primary Care services available to meet healthcare needs
To signpost to other areas of information for Choose Well
To encourage you all to take positive actions in regards to Choosing Well
In the next mins I am going to explain, if you are not already aware, of what the term Primary Care is, give you an overview of the Choose Well message and walk through the various services that are available to you across Primary and Community Services. Often people aren't always aware of the range of services available to them besides visiting A&E or GP and therefore don’t always Choose Well. Armed with the information from this session, you will be able to choose the appropriate health care service for you and your family.
Has anyone heard the term Primary Care or know what it relates to within the NHS?

3. What are Primary Care Services?
Medical Practices (54)
NHS Dental Practices (48)
Opticians (50)
Community Pharmacies (99)
Primary Care is the umbrella term used for GPs, NHS Dentists, Opticians and Community Pharmacies who are all independent contractors. These are all businesses in their own right and are commissioned or contracted to provide NHS services.
Within Hywel Dda we have 54 GP practices, 48 Dental Practices, 50 Opticians 99 Community Pharmacies.
In 2013/14 these contractors provided 2.5m GP appointments, 0.5m Dental appointments and 4.5m Community Pharmacy contacts- compare this to 168,000 A&E attendances across Hywel Dda and you can see they are highly used and a valuable part of the Health Care system. However, people aren’t always aware of all the primary care services available to them.

4. What is Choose Well? Choose Well / Dewis Doeth
Is a guide to choosing the best service for your needs should you become ill or are injured.
Choose Well is a NHS wide campaign running across all the UK which aims to encourage and educate the public about the best service for their healthcare need at that time. It was launched in Hywel Dda in 2013 through the distribution of leaflets containing fridge magnets to all households and some publicity in the local newspapers. We are all too aware of the increasing pressures on our emergency departments not only in Hywel Dda but across the UK. By Choosing Well, you can you access the appropriate service for your needs in the shortest possible time.
The thermometer is the logo for the national campaign. It starts at the bottom with the blue section, being the lowest health need, up to Red, the highest need. The message of choose well is to access the most appropriate level of service for your healthcare needs at any particular time.

5. Why Choose Well?
Choosing the right service allows you to receive the right treatment in the right place
Busy emergency services can help those who need them most
Treatment is given in the shortest possible time
One of the aims of Choose well is that individuals receive the right treatment in the right place, in the shortest possible time. Clearly this benefits everybody. We all know from media reports, how busy hospitals are, especially over the winter months with the level of demand within the A&E departments. This inevitably leads to long waits and sometimes delays for people who need this level of service.
If you access an appropriate health care service then you are likely to get treated quicker and often more locally.

6. SELF CARE Self Care. The first option in the Choose Well Guide is
Starting at the bottom of the thermometer- we have self care. Q: Can anyone think of examples of how you can self-care?
Self Care means looking after yourself and is best for coughs, colds, sore throats, upset stomachs, hangovers and general aches/ pains. This means having simple medications at home such as paracetemol, calpol, cough medicine, items such as resolve for hangovers, indigestion tablets. These and other similar remedies can be obtained over the counter at a community Pharmacy and from many shops.
This all may seem common sense but did you know that evidence suggests that one in four people who attend A&E could have self treated at home?
Self-care is about promoting the idea that everyone has a responsibility to look after their own health, e.g. a persons lifestyle can have a significant impact on long term health needs so maintaining a sensible diet and weight and not drinking excessively and not smoking are all actions that you can take as an individual to look after your own health.
It really is the most convenient service for the above types of ailments and does not need medical assistance. However if symptoms persist you need to think about accessing a higher level of service on the thermometer.

7. ADVICE NHS Direct 0845 46 47 Community pharmacy Health Visitor
Practice Nurse
In terms of advice or questions you might have about your health – there are a number of options:
you can Contact NHS Direct Wales on – there are likely to be changes to this in the coming year as Wales moves to the 111 service as has happened in England.
You can visit your local community pharmacy where trained staff can offer free advice on what treatment/ over the counter medication is best for your needs, or whether you need to access another service. This is an useful first point of contact if you want to speak to someone face to face rather than over the phone.
If you have concerns about a child's health your health visitor would be an appropriate first contact.
Surgeries will have practice nurses who can usually offer appointments that means you don’t have to try and see a GP.

8. COMMUNITY SUPPORT Community pharmacies – advice & signposting
Third Sector (voluntary organisations) – can offer support in a variety of ways e.g. Diabetes UK, locally run support groups.
There are 99 community pharmacies in Hywel Dda and can be found in all towns and many villages and do not require you to make an appointment. Most pharmacies are open on Saturday and some even on Sundays. You might be surprised at the range of services, other than dispensing prescriptions that pharmacies can offer. Many provide free Smoking Cessation support in conjunction with Stop Smoking Wales, offer consultations for supply of the Morning After Pill, accept in sharps bins (1 ltr ) and provide free flu vaccinations for patients that fall into the “At Risk” groups.
Remember, there are many common illnesses and conditions that your local community pharmacy may be able to help with. If they cant help you then they will signpost you onto a different service. Did you know that community pharmacists undergo 5 years of training and are experts on medication.
There are a number of voluntary organisations that can also help with practical issues such as support groups etc. Patients with long term health conditions many find a condition specific support group better for them than routinely visiting a GP for advice. There is a variety of self management education programmes run within the Health Board which can support patients to manage their conditions and have longer health benefits. There is the Education Programme for Patients EPP Cymru – this offers a range of self-management health and well being courses and workshops for people living with a health condition.

9. ROUTINE CARE General Practitioners (Monday to Friday 8.00am-6.30pm)
Community Pharmacies
Optometrists
Dentists
Routine care covers general unwellness, persistent symptoms and the need for regular check-ups.
Seek advice from your GP symptoms that wont go away or are getting worse. It may be that you have sought advice from NHS Direct or pharmacy who have signposted you o your GP.
Normal hours for GP practices are Monday to Friday 8am and 6.30pm. Outside of these hours you can seek access to a GP via the GP Out of Hours service – but this should be for health matters that cant wait until your usual GP practice is open. Routine care would also cover any regular monitoring that is required for specific health conditions e.g. asthma reviews, blood pressure checks etc
Opticians
It is recommended that most people have their eyes tested every 2 years. However, some people will need tests more regularly, e.g. under 16’s, anyone with diabetes, those aged 40 and over with a family history of glaucoma, and those aged 70 and over. Optometrists can test more frequently where there is a clinical need. Did you know that under 16’s have free sight tests and its really important for a child to have a sight test before they reach 9 yrs?
Dental Practices
Its also important for your dental health to have regular check-ups. The interval between check-ups can be anything from 6 months to 2 years depending on your clinical need and advice of your dentist. Whilst there are NHS dentists within Hywel Dda there is limited capacity and a large percentage of the population access private dental care.

10. URGENT CARE GP or GP Out of Hours Service
Optometrist participating in the Welsh Eye Health Examination Service.
NHS Direct ( ) for acute dental pain to access urgent dental access appointments at mid week & weekends
If you have an illness or condition that requires swift intervention, e.g. persistently raised temperature, acute pain, etc you can ring your GP practice during normal operating hours or access the GP Out of Hours Service outside of these times.
If you have concerns about your eyes think about visiting an optician rather than a GP or hospital. New eye symptoms can be associated with vision threatening disease and unless detected and treated early may lead to permanent damage. If you have a suddenly occurring eye problem it is very important to get it examined at the earliest opportunity and the most appropriate place to go for an assessment is a local community optometrist. Examples of urgent symptoms include sudden onset of a red or uncomfortable eye, a foreign body in the eye, sight problems that start quickly, seeking flashes or new floaters in vision. Optometrists will provide an expert examination and advice on eye problems that need urgent attention and the best way to treat them. Optometrists will have more specialised equipment than GP surgeries for examining eyes. If the optometrist decides you need an Eye Health Examination, there will be no charge.
If you have an urgent dental need, you should contact your own dental practice if you have one or if not you can ring NHS Direct who will assess your dental needs in order to assist you in making a urgent dental appointment. This service runs across weekdays and weekends. You do not need to visit A&E with dental pain- no matter how bad the pain is! There are no dentists available within the A&E Dept in Hywel Dda. The nearest hospital that can deal with urgent dental care is Morriston Hospital.

11. EMERGENCY CARE Life Threatening Conditions e.g.
Serious accident or burn
Loss of consciousness
Breathing difficulties
Serious bleeding
Suspected stroke or heart attack
At the very top of the thermometer, we have the highest heath need. This is the time to ring 999 or attend at an A&E Dept.
Some examples are shown on the slide, but these aren’t the ONLY life-threatening or serious emergencies.
A&E, as the name suggests is for Accidents and Emergencies and NOT Anything and Everything.
Just ask yourself whether A&E is the appropriate place for you to visit and if not, what other service might give you quicker access to treatment.
Inappropriate calls to 999 and unnecessary attendances at A&E clog up the emergency care system, lead to increased demand on already busy services and can impact on the time it takes for those that need emergency care to be dealt with.
Examples on Choose Well twitter app:
Last October, someone attended A&E for flea bites
Call from person in Conwy to 999 because she had athletes foot 22/4/15
Woman demanded to be taken into hospital after she was scratched by a cat
A man called 999 to say that he has a heart problem as he is in love with a girl whom he does not know.
A man who claimed he had drunk too much wine called 999 complaining of a terrible hangover.

12. EMERGENCY CARE - DENTAL
Only the following are dental emergencies
Dental bleeding that will not stop
Acute Spreading infection (Swelling of the lip, tongue or cheek)
Damage to teeth or jaws as a result of accident
In these cases patients should be referred directly to the A&E department at Morriston Hospital, Swansea
Toothache, no matter how bad, is not classed as a dental emergency
Usefull to cover off dental emergency care. You may find the list of whats classed as a TRUE dental emergency surprising as it doesn’t include toothache!

13. Want to find out more about Choose Well?
Hywel Dda University Health Board Choose Well Website:
Includes symptom checker, quiz and app
Follow the National Campaign on Twitter @ChooseWellWales
If you want to find out more about Choose Well, more information can be found on the Hywel Dda Health Board website. There is also the national Choose Well website which is simply this site includes a symptom checker, choose well quiz and an app that can be downloaded onto a smart phone which will give you details of primary care services based on your current location.

14. Choose Well / Dewis Doeth
A guide to choosing the best service for your needs should you become ill or are injured..
Join Hywel in Choosing Well, to support responsible use of the NHS.

15. Any Questions?