The Strategic Assessment of Primary Care in Ayrshire and Arran undertaken in 2014 found the vision set out in the local Primary Care strategy Your Health – We’re in it Together (2009) offered a firm foundation for further development as we move forward with integrated Health and Social Care Partnerships (HSCPs). Widespread engagement underpinned the strategy and its implementation led to the shifts in the balance of care in relation to access to diagnostics for a number of conditions, the piloting of telemedicine, Practitioners with Specialist Interest and community-based alternatives to emergency admission.
The Strategic Assessment therefore includes plans to revisit the strategic priorities under the leadership of the Health and Social Care Partnerships. Within the Strategic Assessment, a number of areas for development are identified. These include:
• Ensuring that Primary Care is embedded in locality planning arrangements within HSCPs;
• Raising the profile of the Primary Care Information System as a tool for locality needs assessment and service planning within HSCPs;
• Taking forward the Primary Care Premises Development Plan in line with the priority assessment, available budget; and
• Workforce planning to address pressures associated with recruitment to General Practice, based on evaluation of demand and capacity.
During 2015/16 we will build on our innovative use of new technology, both to digitally connect people and communities, to maintain wellbeing and support self-management but also home-based monitoring and management solutions for people with long-term conditions. Programmes of work will aim to empower patients who wish and are able to self-care with support and information including web-based resources.
Partnerships will put in place Joint Strategic Commissioning Plans based on an agreed shared assessment of need within partnership areas including intelligence from locality engagement.
From 2015/16, place-based approaches to support primary care will be further developed through Health and Social Care Partnerships locality working arrangements. There will be considerable opportunities from integrated Health and Social Care Partnerships in relation to collectively considering the contributions to supporting people in the community from the third and independent sectors, clinicians, social workers, other professionals, local service users and communities. This will include exploring how collaboration with the voluntary and third sectors can support hard to reach or seldom heard communities.
NHS Ayrshire and Arran will develop and refine care pathways to ensure input of Primary and Community Care to Care Pathways associated with Building for Better Care and the Combined Assessment Unit model. Engagement with Primary Care in developing and testing new models of care to reduce unscheduled care and promote integrated working will also take place.
Partners will need to assess Primary Care infrastructure with a view to future capacity and design requirements in the context of changing demographics, complexity of care and the range of community-based services. This will also involve exploring innovative opportunities for developing capacity and infrastructure in Primary Care to fit with these future requirements. The sharing of best practice models and resourcing at a national level could assist with this work.
The increase in General Dental Practitioners numbers within Ayrshire and Arran has allowed the Public Dental Service to realign its' care into a hub and spoke model, with a review of the outlying premises that are now little used, or are no longer fit for purpose. This has resulted in the identification of some premises that can be released to other services, and others whose lease can be considered for termination.
Workstreams to take forward the development of eHealth in relation to appropriate information sharing to support quality person-centred care at the point of care will be taken forward.
Workforce planning at whole system and partnership levels to address recruitment and retention issues and develop the skills-mix required will be a key focus.
Underpinning this will be a focus on organisational development centred on positive collaborative culture, good relationships and leadership.
4.1.7. Building for Better Care
The NHS Boards Building for Better Care capital investment programme sets out a new vision of how acute unscheduled care will be organised in the future. The Boards Local Unscheduled Care Action Plan (LUCAP) includes many clinical improvements set out in Building for Better Care. These will accelerate progress and bring about transformation of services ahead of the fit for purpose new build facilities.
These plans and the targeted interventions and redesigns they describe will strengthen community and primary care services in support of the unscheduled and emergency care agenda. The Out of Hospital Care Action Plans is transformational and sustainable, bringing about fundamental changes that will deliver against all related HEAT targets and the six key quality outcomes of the NHS Quality Strategy. In addition sustained delivery and improvement against the
relevant HEAT targets will provide tangible evidence of progress towards the 2020 Vision.
The Board’s Emergency Care Quality Improvement Programme (ECQIP) is addressing this challenge through changes and actions set out in the LUCAP which are fully consistent with the new ways of working and new clinical models required for the Building for Better Care capital investment programme. These combined will transform unscheduled care in Ayrshire and Arran and deliver sustained a four hour standard compliance.