1 a Meeting of the Aneurin Bevan University Health Board Public

Agenda

A meeting of the Aneurin Bevan University Health Board Public Partnerships and Wellbeing Committee will be held on Thursday 9th November 2017 at 9:30am to 12:30pm in the Executive Meeting Room, Headquarters, St Cadoc’s Hospital

AGENDA

Preliminary Matters 9:30

1.1 Welcome and Introductions Verbal Chair 5 mins 1.2 Apologies for Absence Verbal Chair

1.3 Declarations of Interest Verbal Chair

Items for Assurance 9:35

2.1 Risk Register Attachment Will Beer 10 Items for Next Meeting mins 2.2 Plan for a Primary Care Service Attachment Liam Taylor 15 for Wales up to March 2018 mins 2.3 Primary Care Annual Report – Attachment Liam Taylor 5 for information mins 2.4 Gwent Regional Well Being Attachment Jennifer Evans assessment and Priorities Identification Project outcome 2.5 Update on the process for Verbal Sarah Aitken developing the Health Board’s response to the Gwent PSBs Wellbeing Plans Items for Information 12.10

3.1 Social Services and Well Being Attachment Chair Act Regional Partnership Board Minutes – Thursday 7th September 2017 12.10 Final Matters

4.1 Draft Minutes of the Committee Attachment Chair 5 – 14th September 2017- For mins approval 4.2 Action Sheet – 14th September Attachment Chair 2017 – For approval 4.3 Matters Arising Chair

Public Partnerships and Well Being Committee-09/11/17 1 of 147 Agenda

4.4 Items for Board Consideration Chair To agree agenda items for Board consideration and decision

Date of Next Meeting

TBC at 9:30am in the Executive Meeting Room Headquarters, St Cadoc’s Chair Hospital, Caerleon

2 of 147 Public Partnerships and Well Being Committee-09/11/17 Tab 2.1 Risk Register

Public Health and Partnerships Committee Risk Register 9/07/2015

Likelihood score Consequence score Abbreviations - risk ownership 1-rare 2-unlikely 3-possible 4-likely 5-almost certain 5-catastrophic 5 10 15 20 25 DPH Director of Public Health 4-major 4 8 12 16 20 DTh Director of Therapies 3-moderate 3 6 9 12 15 DPl Director of Planning 2-minor 2 4 6 8 10 1-negligible 1 2 3 4 5 DOps Director of Operations DW Director of Workforce Development NB 'Consequence' scores have been intrepreted through the agreement of intuitive scores by a group of DivPCN Divisional Director of Primary Care & Networks public health specialists, taking into account the proportion of the population affected, the severity of that effect, and the contribution to the overall burden of poor health in ABUHB population. DivFT Divisional Director of Family & Therapies Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public

Amended risk Current risk score (if score mitigated by (consequence planned and Risk issue: Standard x likelihood) Date added Risk Analysis and existing action / funded action) 3 'Standards for Residual / new risks to population health Actions required from ABUHB and /or partners to reduce the risk owner Review controls Healthcare Services' date

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1. We do not have i) We have Board Committees The remit of the committee is broader than the Public Health and Partnerships 3x3 1x2 Terms of reference for public partnerships to include the contribution of public health 1x3 1x2 July 2016, DPH, systems in place to for Public Partnerships and Committee, it includes providing assurance against Primary Care and Community solutions to wellbeing priorities. identify and act Wellbeing and for Quality and Services performance and sustainability as well as ABUHB response to the Social Review: April 2017 upon significant Patient Safety Care and Wellbeing (Wales) Act 2014 and the Wellbeing of Future Generations Public Partnerships and Wellbeing Risk Register include risks against the failure to public health issues (Wales) Act 2015. This provides a risk that public health priorities might not deliver on significant public health solutions to wellbeing priorities. receive the same level of scrutiny within corporate governance processes for ABUHB. Assurance on Staying Healthy, theme one, of the Health and Care Standards reports organisational assurance through the Quality and Patient Safety processes.

ii) The Director of Public Health DPH post will become vacant, need to ensure interim and future arrangements 1x2 1x2 DPH now in post providing system leadership across the range of public health 1x2 1x2 Sept 2014, DPH. has close links to Public Health continue to support this risk. functions. New DPH continues in the role as Vice Chair of the Gwent APB for Wales and regional Health Substance Misuse. Review: April 2017 Protection teams. DPH also sits on the Gwent Local Resilience forum and is Vice Chair of the Gwent APB for Substance Misuse.

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iii) The local Public Health Team Welsh Government funded anti-poverty programmes together deliver a number 4x2 2x2 Further investment required to support community based and longer term 3x2 2x2 Sept 2014, DPH, and Primary Care and Networks of health programmes with, and on behalf of, the Health Board as well as programmes. Also, further joint work required with community based partners and Division work closely with focussing on those most in need... eg. expert patient programmes for chronic ill other statutory bodies such as social care. Review: July 2017 community groups, Local health, and community weight management services. These programmes are

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public Authorities and other Health facing significant change Work on an Integrated Wellbeing Network at NCN level to get highest value from the Board Divisions to support collaboration between community wellbeing services acting in a coordinated way with health improvement, health There has been 30% disinvestment in Communities First from Welsh Government the citizen’s needs at their core. protection and healthcare for 2017 2018. Communities First will cease to operate from financial year 2018 quality improvement. to 2019. Health Board liaise with Local Authorities to understand the impact of the changes to Consultants in Public Health the anti-poverty programmes in Gwent. support all the other Health The WG focus on community resilience, employment and prosperity for the Board Divisions, each remainder of the anti poverty programmes poses a risk that they will have less Recognising health and wellbeing as a pre-requisite of community resilience, Neighbourhood Care Network focus on ‘health’ programmes they currently deliver. employment and prosperity, the UHB are working with Public Service Boards to and each Local Authority ensure that the response analyes and wellbeing plans contain actions to mitigate through the PSB wellbeing against this risk including influencing the use of the Communities First Legacy Fund to

assessment and planning be made available by WG. processes. Consultants in Public

Health also lead on specific health improvement topics. 2 2.1 1. We do not have systems in place to identify and act upon significant public health issues Tab 2.1 Risk Register

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iv) ABUHB include key action on Multiagency Wellbeing Plans will become a statutory requirement for the Public 4x4 3x5 The five PSBs have now begun work on the response analysis and development of 4x4 3x5 Sept,2017 DPH, health improvement and Service Boards in 2018 under the Well-being of Future Generations (Wales) Act their wellbeing plans. ABUHB Executive team has agreed a set of priorites that for inequalities in health within the 2015, and PSBs have all been out to consultation on their wellbeing assessments. Well-being plans, that fit with the 10 well-being objectives developed for the ABUHB Review: Dec 2017 IMTP. There is a risk that the individual duty. These will be considered by the Public Partnerships and Well-being

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public IMTP commitments on We need to ensure a robust framework for the health improvement and reducing Committee. improving public health do not inequalities content of these plans across Gwent, to ensure that those actions track through to Divisional which are vital, outside the powers of the Health Board, but within the power of Population Needs Assessment required for the Social Care and Wellbeing (Wales) Act Plans. other public sector organisations, are included within them. 2014 has been signed off at ABUHB Public Board and at the statutory Regional Health improvement actions Partnership Board. are included in all of the The requirements to consider social, economic and environmental sustainability Neighbourhood Care Network will also provide a framework for considering health improvement. The Act The Health Board, Local Authorities and other partners will use these processes to plans. requires, for the first time, consideration of both short and long term issues. We carefully consider their respective contributions to population health improvement Public Health and ABUHB input need to be careful that key health improvement issues do not get lost in the new actions. has been provided to all LA-area planning frameworks. Wellbeing Assessments and support will continue to Both resources and a degree of organisational stability are required for effective Wellbeing Plan development Well-being Plans to be designed and implemented. The Health Board is also through 2017. experiencing increasing demands on its resources. A Gwent-wide multiagency group has commissioned work Failure to adopt evidence based actions to improve population health at scale will to develop a set of priorities to also fail to reduce the burden of preventable health and social care need. be progressed at a regional (Gwent) level.

2. We fail to ensure (i) see 1(i) - (iv) above The local public health team, Primary Care, Networks and Community Services 2x3 3x3 We need to ensure the maximum effectiveness of resources through effective 2x3 3x3 September 2014, that needs Division and Planning Division have limited capacity to support comprehensive prioritisation, service planning, policy and practice development. DPH and DPl, assessment and needs assessments and service reviews. public health advice We also need to ensure that completed needs assessment work is actually used to Review: October informs service develop and adapt services to better meet the needs of the population. 2017 planning, policies and practice. NCN needs assessments and PSB Wellbeing Assessments have support from the public health teams.

(ii) The Health Board is There may be other vulnerable groups with unmet needs where targetted work is 2x3 3x3 We need an overview of all locally relevant vulnerable groups and potential/actual 2x3 3x3 Sept 2014, DPH currently undertaking or not being undertaken, and there are cetainly some where work has been delayed service improvment work to try to prioritise support for those in greatest need. We and DPl, participating in various needs due to other commitments. NB Risks re Prison Health Service provision in Primary also need to ensure follow though actions once needs assessment has been assessments of vulnerable Care & Networks Divisional Risk Register. (and possibly other services specifically completed. Review: October groups aimed at vulnerable groups in this and other Divisional Risk Registers). It is 2017 unclear who is responsible for prioritisation of such work at present.

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(iii) Work on Choosing Wisely is This work comes under the 'Quality and Patient Safety' Committee, and relevant Medical Director ongoing. risks should be documented in the Risk Register of the respective operational divisions. Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public

(iv) ABUHB collective and PSBs have published their well-being assessments and are now working on their 3X5 3X5 This engagement needs to broaden to include support from Primary Care, Networks 3X4 3X3 individual duty to the Wellbeing well-being objectives and plans. ABUHB has identified executive and independent and Community Division, Planning and other Divisions where appropriate. ABUHB of Future Generations Wales representatives for all five PSBs, and Public Heath Team and some partnership partnership support should have clarity of role and responsibilities as well as a Act is not adequatley fulfilled officers are supporting the planning groups that are part of the PSB structure. mandate to negotiate organisational action in Partnership. and ABUHB response is not sufficiently robust to meet ABUHB has published its well-being statement and objectives as part of the IMTP. ABUHB is working with Wales Audit Office as one of the pilot sites for testing the identified need nor external A steering group has been established and this is working on a well-being rapid approach to audit, and this will include the SCCC and Clinical Futures programme. audit. assessment planner tool that will be developed initially with three areas (Finance, Facilities and Workforce and OD).

There is now an urgent need for programme manager support to coordinate the ABUHB WBFGA work. This need/risk is currently being held by the Chair of the ABUHB WBFGA steering group – the Board secretary.

(v) ABUHB holds a joint The Population Needs Assessment has been published and the Regional Area Plan 4X5 4X4 Head of Partnerships appointed withing the Planning Directorate who will provide the 4X5 4X3 responsibility with the 5 local now needs to be developed, consulted upon and published by 1st April 2018. UHB lead for developing the Area Plan. authorities to publish a fully

consulted on Gwent Regional Currently there is no identified UHB lead for developing the Area Plan. Area Plan based on the

published Population Needs Assessment. 4 2.1 Tab 2.1 Risk Register

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3. We fail to support (i)Local Public Health team and Lack of sufficient support and programme alignment runs the risk of ineffective 4x4 4x4 A new cross-government focus to 'replace' Communities First is described with three 4x3 4x4 Sept 2014, DPH citizens to maintain Family and Therapies divisional activity in these communities and populations in most need of support with main aims: helping people into work, giving children the best start in life, and ensuring and DOps, and improve their staff are attempting to support health improvement. people’s voices are heard in the design of local services. This sucessor programme is health, wellbeing Communities First, Flying Start referred to as the 3 'E' - employment, early years and empowerment. Review: May 2017

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public and independence and Families First programmes Whilst there is significant variation in activity within different localities from the in delivery of targeted health existing anti-poverty programmes (Flying Start, Families First and Communities A WG legacy fund of £6 million will be introduced in April 2018, to local authorities, in education and promotion First), they currently deliver many community health improvement projects. consultation with communities and public services boards, to maintain some of the programmes. However: all three programmes are currently only funded annually, Families First most effective interventions or community assets developed by Communities First. is scheduled to have a change of focus to community resilience and employment Local anti poverty initiatives and, Communities First is going to be phased out by March 2018. There is risk of We need to ensure close partnership working through the PSB wellbeing planning also support health reduction in community provision of health improvement and wellbeing activity, process as described AND with LAs as they asses impact and effectiveness of health improvement within the most particularly in more disadvantaged areas, and at a time when the NHS is looking improvement programmes currently delivered through Communities First and deprived populations. to more prudent models of primary and community care to meet increasing develop bids to the Legacy Fund for local sustainability. demand. Ensuring a joint approach to planning activity which meets both the evidence base for There is increased risk that the outcomes will be seen as a whole and that population health improvement and Welsh Government priorities is needed to align Communities First (particularly) will reduce healthy lifestyle activity moving everyone's agendas and maximise population health improvement. towards employment, learning and prosperity.

(ii)Community Health Failure to maintain and expand this network may represent a lost opportunity to 2x4 3x4 Increasing this programme will require considerable input by and investment in 2x4 3x4 January 2015, Champions Network promote healthier lifestyle and other health messages into communities where voluntary sector groups, at increased scale and pace to initiate the necessary culture DPH, established, with a limited information tends to be acquired 'word of mouth' from trusted community change within the population. This is currently not planned or resourced. number of individuals and members. Such communities often contain the individuals with the worst health Review: April 2017 training programmes currently and least healthy lifestyles. Short-term monies have been identified to support the continuation of the involved. Outcome evaluation from this type of activity is extremely difficult, although programme, and to allow a sustainability plan to be developed. The Gwent research suggests that trained volunteers working like this does improve programme however cannot continue after March 2018 without identifying new knowledge and lifestyles in fellow community members. resources. Due to the discontinuation of the Wellbeing Activity Grant funding this programme is at risk. Public Health Wales are consulting with Third Sector organisations currently with a view to supporting them with their own improvement agenda.

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4. We fail to (i)Patient education Not all willing individuals with common chronic conditions are receiving 4x4 4x4 We need to map such programmes alongside evidence base, demand and capacity to 4x4 4x4 Sept 2014, DPH promote healthy programmes are provided comprehensive support and guidance in self management of their condition. This enable a planned programme of investment to ensure maximum population impact. and DOps, lifestyles and healthy within the Health Board area, affects a large and increasing proportion of the population. In the short term this Plans are in place in the current ABUHB 3 year plan, but resources have not yet been choices but may not be sufficient to avoids the need for additional staff and ensures existing staff time is used for identified. Review: October

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public ensure population impact. clinical care. However, in the short to medium term, inability to appropriately self 2017 Work is now ongoing wihtin the manage creates avoidable demand on health services, and wastes resources, UHB should map the impact of the changes to Communities First delivery of patient Primary Care & Netwroks to including drugs, consumables and equipment as well as time in clinics etc. In the education programmes. review education programmes long term insufficent patient education at a population level maintains demand available to patients, and in and dependency on health services and creates avoidable ill health. Sectors of particular to increase the the population with impaired literacy levels, physical, sensory or learning availability of diabetes disabilities, or from an ethnic minority community may be at particular risk. OA education. Knee patient eductaion groups implementing prudent care are now operational.

(ii)Work on 'Making Every Contact with health professionals presents a window of opportunity to enable 2x5 3x5 The MECC Strategy has been agreed at Board, with an ambitious target to train and 2x5 3x5 Sept 2014, DPH Contact Count' ongoing with patients to give serious consideration of the effect of aspects of their lifestyle on equip 10% of the front-line staff in brief intervention/advice. and DOps, some staff groups, but all staff their health, and consider or start making changes to that lifestyle. This affects a in direct patient contact need to large proportion of the population - around 2/3 are overweight or obese, and A training plan has been developed alongside the strategy identifying which staff Review: October take this approach in order to around 1/4 smoke. Around 85% of individuals will have contact with a NHS groups require certain training and, both internally delivered and commissioned 2017 ensure population impact. . healthcare professional during the course of any one year. training has been planned with a number of Divisions and professional groups for 2017/18. Failure to have as many staff as possible trained to recognise appropriate opportunities and tackle health-harming behaviours in an effective brief This will require greater scale and pace of change over a prolonged time to initiate the intervention with patients will reduce the potential population impact as well as necessary culture change among staff and patients. supporting effective disease management. Not conducting brief intervention will, in the short term, enable staff to see more patients in a given time period. However, in the medium to long term the absence of brief advice on health- harming behaviours will waste opportunities for health improvement, therefore maintain demand and dependency on health services.

Comprehensive staff involvement with MECC will help individual lifestyle change

support get to all sectors of the population, including those who normally do not access it. 6 2.1 4. We fail to promote healthy lifestyles and healthy choices Tab 2.1 Risk Register

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(iii)Smoking cessation services This should contribute to a measurable population effect on smoking prevalence 4x3 4x4 All Divisions, and as many partners as possible need to encourage, identify, and 3x3 3x2 Sept 2014, DPH are being improved and in next few years, in line with Welsh Government target to reduce smoking systematically refer smokers to SSW or Pharmacy services to support a quit attempt. and DOps, extended to increase prevalence to 16% by 2020. Smoking remains a serious threat to population Extension of the current plan to increase level 3 pharmacy services is being throughput to 5% of all health. This activity will need to be monitored to ensure it has the desired effect, implemented. Divisions and partners need to encourage appropriate staff to Review: April 2018

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public smokers, as required by the and alterations considered if not. Directors of PH are engaged in discussion with undertake 'brief intervention' training to increase their skills and confidence in talking Welsh Government target Public Health Wales (PHW) and Stop Smoking Wales (SSW) re improvements in to smokers about making a quit attempt. Smoking Cessation services through the national tobacco leads representing each WG Tier 1 Target Health Board area. Funded plans are currently in place to increase the numbers of Pharmacies providing 5% of smokers make a quit level 3 services, and work is underway to support them to deliver. We now receive attempt via smoking cessation Action plans will be implemented to increase uptake of smoking cessation regular data reports for this financial year 2017/18 which has enabled data profiles to services, with at least a 40% CO services to achieve the 5% target. be produced for NCNs. validated quit rate at 4 weeks. 2016/17 implement action plans to increase uptake of smoking cessation services to reach 5% target by March 2019, with 3.3% by March 2017. The year on year improvement in smoking cessation performance has continued, ABUHB IMTP Target largely due to the Level 3 Pharmacy service. Smoking cessation services (including 2017/18 Implement action Community pharmacy level 3, Stop Smoking Wales, Hospital Smoke Free Support plans to increase uptake of Service and Prisons) have treated 3% (2,090) of the adult smoking population between smoking cessation services to 1st April 2016 and 31st March 2017; and is on track to reach 3.5% of treated smokers reach 5% target over the year to March 2018. Projected Target IMTP 2017/18 (Based on current A successful social marketing programe Help 2 Quit, has been running from the AB resources/budget allocation for Gwent public health team which has used social insight to inform strong and relevant Tobacco Control): 3.5% messages for important segments of the population pushed through digital, social, radio, pop-up shops and out-of-home advertising channels.

(iv)Support for pregnant Although the numbers involved are small, smoking in pregnancy represents a 3x4 4x4 Partners need to support efforts to support pregnant women in not smoking, and to 3x3 3x2 Sept 2014, DPH women to quit smoking is on- considerable risk to the health of the mother and a lifelong health risk to the ensure young women and girls are aware of the risk to babies, and are encouraged to and DOps, going. child. Supporting pregnant women to stop smoking requires skilled support over adopt alternative coping strategies where required. Additional HB investment was a considerable time. One Local Authority has funded a Healthy Babies Advisor provided to increase resources (CO monitors) available for community midwives to Review: April 2018 post for the Torfaen area. implement NICE smoking cessation guidance. The maternity service implementation of NICE smoking cessation guidance is currently being audited to establish further support midwives require to embed activity within day-to-day work.

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(v) We do not currently have Prisons have gone smokefree. Prison healthcare team need to provide lifestyle 2x2 2x2 Additional resources and training of existing staff has been undertaken. Primary care 2x2 2x2 Sept 2014, DPH smoking cessation services advice to support prisoners. A member of HB staff team has been identified and have received funding for prison smoke free service. Resources to support and DOps, targeted at any vulnerable provided smoking cessation support on a fixed term secondment to the Prisons. implementation have been developed and staff capacity to deliver smoking cessation groups apart from a service in Discussions are currently underway with MIND regional co-ordinator in relation identified and implemented with the prison setting. Mind Cymru has received funding Review: April

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public prisons and a nation project to a potential pilot smoking cessation service for clients experiencing mental from WG to support local Mind Groups to provide smoking cessation support for 2018 delivered locally by MIND for health issues. clients experiencing mental health issues. clients experiencing mental health issues.

(vi)All surgical departments This is a major missed opportunity to avoid ill health in the short medium and 2x4 3x4 Better engagement by surgical specialities could greatly increase the numbers going 2x4 3x4 Sept 2014, DPH including obstetrics and long term. Current referral appears to depend on the enthusiasm of a small through this programme. In the short term this would avoid a few (potentially very) and DOps, gynaecology have adopted number of individuals rather than being a routine and normal part of long hospital stays and enable more activity, but longterm this could also contribute to policy of encouraging smokers deliberations around and preparation for surgical interventions. a more general reduction in smoking prevalence as some of those who quit for a few Review: April 2018 to quit for at least 8 weeks prior weeks prior to surgery will remain non smokers. Again, many of these individuals have to elective surgery, but referral a circle of friends and relatives, who may also be influenced to reduce less healthy rates of smokers listed for behaviours. This is an aspiration on the part of the Tobacco Control group, and action surgery to quit services remain plan is being updated by scheduled care in relation to Pre-op smoking cessation. low

(vii)The adult weight Failure of this service to keep up with demand, and failure to extend the service 4x5 3x4 Additional resource will be required to implement this service in the face of rising 4X5 3x4 Sept 2014, DPH management service is now for children and young people will reduce the enthusiasm of wider NHS staff to demand and prevalence of obesity. The Specialist Adult Weight Management Service and DTh, fully functional, and the last initiate discussions around weight and weight management with patients. Failure is now fully in place and plans have been developed to expand the service with an remaining planned staff are in to maximise the numbers of patients engaging with the service will also fail to additional operational site providing more equitable access. Review: October post. reduce potential demand for diabetic, cardiovascular etc health services. 2017 A Business plan for a Childrens Weight Management Services has been agreed at The IMTP commitment and Executive Team agreement to extend the adult Executive Team. Therapies and Public Health service leads are working with F&T weight management service to include a childhood and family weight Division and Finance to identify resource to implement the service.

management intervention has not been met. NCNs are prioritising obesity and taking a leadership role in beginning the

There is no evidence-based service for children with morbid obesity and their development of Level 2 services, led by Newport East NCN. families, this could pose organisational and clinical risk. 8 2.1 4. We fail to promote healthy lifestyles and healthy choices Tab 2.1 Risk Register

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(viii) the antenatal weight Part of the Adult Weight Management Service, this service is beneficial to small 3x3 3x4 More resource is required to ensure all antenatal services can provide this level of 3x2 3x3 Sept 2014, DPH management service appears to numbers of women, but is not currently able to impact on the whole population support. Some partners have invested in the service on a short term basis, but this and DTh, be working well in Torfaen and of pregnant women. Obesity has a major impact on the health of pregnant would ideally be a core service within the adult weight mangement service. Resources is being expanded to women, and also on the lifelong health of the child. The prevalence of obesity is not yet identified. Review: July 2017

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public Monmouthshire. high and continuing to rise, particularly in those living in the most deprived areas. Some resource has been invested from NCNs in Blaenau Gwent to expand obesity services generally and specifically including antenatal weight management and in Monmouthshire.

The Gwent childhood obesity strategy has been agreed at all PSBs and features in current iterations of the wellbeing assessments. We continue to work closely with the Wellbeing Plan development processes.

The ABUHB Healthy Weights Delivery Group has agreed a delivery plan for 2017/18 and preparation for implementation has begun.

(ix) ABUHB has a breastfeeding ABUHB continues to have low rates of breastfeeding. While Community and 2x3 2x3 Further work by ABUHB and partners is required to increase breastfeeding rates. Work 2x4 1x4 January 2015, policy and aims to encourage Hospital services have recently acheived the Unicef 'Baby Friendly' award, which is now completed to capture breasfeeding rates on Child Health System which is on DivFT, and support all new mothers to aims to ensure that all processes are in place to maximise support for track with improved rates of recording. breastfeed their babies if breastfeeding. Review: April 2018 possible. Breastfeeding contributes to many aspects of lifelong good health.

(x) We do not currently have Resources do not currently allow this, but lack of such services is contributing 2x2 2x3 Additional resources would be required for this, not yet identified. Blaenau Gwent 2x2 2x3 September 2014, weight management services towards inequalities of both health and service provision. NCNs have added to the capacity of the adult weight management service in deprived DPH and DTh, targeted at any vulnerable areas and for specific groups. groups. Review: September 2017

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(xi)Public Health Wales , the Not all schools and education officers appreciate the benefits of a universal 3x2 3x1 The Public Health team is supports schools via the Healthy Schools Officers on a 4x1 4x1 Sept 2014, DPH local Public Health team and system attempting to ensure the ethos of a school suppport health education and Gwent wide basis. Board Members and staff can be effective advocates for the and DOps, Family & Therapies divisional promotion, particularly in a time of diminishing budgets and a focus on literacy, added value of the Healthy Schools Scheme in improving the ability of pupils to staff support local schools in numeracy and exam results. improve literacy, numeracy and general behaviour. Review: April

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public maintaining membership of the 2017 'Healthy Schools' scheme.

(xii)'Design to Smile' dental Not all schools are prepared to co-operate with the supervised tooth brushing. 3x4 3x5 Schools need to be encouraged to co-operate with this programme, which will require 3x4 3x5 February 2015, public health initiative is trying This reduces the likelihood of children in the more deprived areas acquiring good the support of partners. DivFT/DPH, to work with Primary schools in dental hygiene habits for life. Poor dental health can adversely affect self deprived areas to encourage confidence and diet, as well as potentially requiring unecessary risk from general Review: March

uptake of an evidence based anaesthesia for treatment in children. 2018 programme of fissure sealant /

fluoride varnish treatment and supervised tooth brushing. 10 2.1 4. We fail to promote healthy lifestyles and healthy choices Tab 2.1 Risk Register

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(xiii) Although hazardous We have no systematic means of identifying individuals at risk and offering 4x4 4x4 A clear plan is needed to encompass all aspects of alcohol harm reduction, and 4x4 4x4 January 2015, alcohol consumption may be support, although several staff groups have been offered alcohol brief resources need to be planned and secured. DPH, DOps and reducing, particularly in intervention training. DivPCN, younger people, the health Evidence-base alcohol treatment pathway developed, business case directed to

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public effects of previous hazardous finance and performance committee for services in RGH, NHH and YYF. Review: October consumption by a large sector 2018 of the population are now the APB has re-commissioned new all-Gwent community drug and alcohol services starting to become apparent, (GDAS) for adults. Planned service expansion following commissioning process next with increasing rates of alcohol year related ill health and hospital admission. The UHB fulfils statutory role as Responsible Authority on Licensing applications.

An Alcohol Care Team has been established at the RGH and NHH aims to reduce alcohol-related harm by raising awareness among hospital staff of alcohol-related ill health, screening for alcohol misuse problems and providing specialist care to patients that are drinking at harmful or dependant levels. The specialist support available to patients includes comprehensive alcohol use assessments, care planning, medically assisted withdrawal (often called “detox”) and psychological support.

5. We fail to (i)A Workplace Health Group 1x2 1x2 Maintenance of this group and activity. 1x2 1x2 Sept 2014, DPH promote healthy and oversees workplace health and and DWD, safe workplaces wellbeing issues. A very large proportion of the population Review: October enter ABUHB premises as either 2017 staff, patients or visitors each year, and this is an opportunity for demonstrating exemplar policies and practices promoting health.

(ii) ABUHB has been awarded 1x2 1x2 The Health Board has acheived the platinum standard, the highest available level. 1x1 1x1 Sept 2014, DPH the Platinum level Corporate Maintenance of current systems. and DWD, Health Standard Review: December 2017

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(iii)A staff 'wellbeing through Ongoing encouragement of small steps leading to wider culture change is going 2x4 3x4 The Work and Health Group will need to develop, implement and revise actions plans 2x4 3x4 Sept 2014, DPH food and physical activity' to be important here, and we need to be careful to ensure that over enthusiastic over the next couple of years as outlined in the policy. Resources to do this are not and DWD, guidelines have been policy does not alienate staff, while keeping a constant degree of movement currently identified, although some may be available. developed, owned by the Work towards ideals. If we manage to set up a rolling programme of reform and Review October

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public and Health Group. engagement, with a background communications initiative, this should slowly Small Change Big Difference social marketing campaign prepared and work with 2017 improve the food and physical activity environment for staff and visitors. facilities and catering plans to increase healthy food offer and improve active travel.

(iv)A ‘smoke free premises’ Difficulties remain in fully implementing the ‘smoke free’ policy at some locations 2x3 2x4 Permanent funding has been secured and recruitment underway to recruit 2x1 2x1 Sept 2014, DPH policy has been agreed and in some ABUHB sites. Failure to render NHS property (and staff at work in enforcement officers to permanent posts.The new model of smoking wardens and DOps, April partially implemented. Two uniform) smoke free undermines the wider efforts to reduce smoking in the adopting an enforcement approach has worked well and policy is currently being 2018 fixed term smoking wardens population. Patients who continue to smoke are often those most at risk of harm updated. Banning smoking on hospital grounds was also included in the Public Health have been employed. A hospital and increased need of health services. (Wales) Act.

based smoking cessation service has now been set up, with

access being rolled out to all acute hospitals. 12 2.1 5. We fail to promote healthy and safe workplaces Tab 2.1 Risk Register

Public Health and Partnerships Committee Risk Register 9/07/2015

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(iv)Flu immunisation is offered Frontline Healthcare workers at increased risk of contracting flu virus than the 3x4 3x4 This requires an ongoing plan and learning from best practice across Wales. It also 3x4 3x4 Sept 2014,DPH to all front line staff each rest of the population in their work and may potentially transmit flu virus to requires senior staff in all divisions to understand the rationale for flu vaccination and and DWD, autumn. vulnerable patients. Therefore flu vaccination is offered to staff to protect them encourage staff to have it every year. Culture change by staff is probably more Review: April 2017 and vulnerable patients and is a Health Board Tier 1 Target. The consequences of important than additional resources, and this is slow.

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public Develop and implement a staff low uptake levels will depend on the type and level of flu circulating in the influenza policy and deliver community, but raising uptake levels provides the best defence possible against The ABUHB Strategic Immunisation Group oversaw a systematic approach to all influenza immunisation harm to both the population health and health board services. Maximising staff elements of the delivery of the staff immunisation programme to achieve the target programme to improve uptake uptake levels promotes staff wellbeing and potentially reduces the risk to uptake rate this year. Based on learning from previous years and findings of a staff amongst ABUHB staff to achieve business continuity at the Health Board by limiting the harm from flu virus survey, systems have been put in place to share robust information with all staff to 50% uptake. contained (or recently contained) within vaccine. Effects likely to be mainly short enable them to make an informed decision regarding the vaccine and to facilitate a term, but can be longer term if previous virus strains re-emerge. In 2016, Welsh genuine 100 per cent offer to staff members in their place of work. Government funding to support the flu vaccination of staff has been discontinued. 161 Flu Champions were recruited and trained to deliver vaccine on all major health board sites and across all Divisions. Site specific information regarding access to the Health boards currently have a tier one target from Welsh Government to vaccine was mapped out. This approach was complemented by the occupational acheive 60% flu immunisation of all front line NHS staff. health team vaccinating at large meetings and in clinics.

Health Boards are expected to resource this immunisation programme and whilst A comprehensive, positive and sustained communications plan was implemented, it is a cost effective, preventative measure, no recurrant resource is identified. reflecting both national and local themes.

Uptake (as of 07/03/2017) for staff with direct patient care was 50% which means the Health Board has achieved the Welsh Government target for the first time. ABUHB uptake is roughly in line with the Wales rate (51%) and it is the 4th highest uptake at Health Board level.

Since the start of the 2018 seasonal flu campaign a Programme Manager has been appointed and more flu champions have been trained than in previous years. As at end of Oct 18 over 1,000 more vaccinations had been given compared to the same period last season.

15 of 147 15 13 2.1 16 of 147 16 Tab 2.1 Risk Register

Public Health and Partnerships Committee Risk Register 9/07/2015

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6. We fail to have (i)The Director of Public Health We currently have a small health protection team based within the ABHB area. 2x3 2x2 The loss of organisational intelligence from the retiring CCDC is inevitable, but 1x2 1x1 Decmber 2014, systems and plans to has close links with Public The long standing CCDC has retired, and PHW is curently considering the re- maintaining a Gwent base for the health protection team would help to mitigate this DPH, prevent and control Health Wales and a local Health location of this team to Cardiff, to be co-located with the team serving Cardiff by facilitating the maintenance of local relationships and efficient working. This has communicable Protection Team is located and Vale and Cwm Taf Health Boards. There is concern that relocation outside been agreed by Public Health Wales. Since being appointed, the new CCDC in the Review: April

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public disease outbreaks within the Health Board area. Gwent will jeopardise vital local links and destabilise the efficient functioning of Gwent Health Protection Team has been seconded to Screening Services. PHW have 2017 and provide The local HPT team currently the team. put cover arrangements in place for this CCDC post. immunisation maintain good links with both local partners (e.g. LA Environmental Health & Education depts, Gwent Police and the LRF)and colleagues in Cardiff, including the provision of cross cover and sharing some nursing staff.

(ii)The Health Board is aware of 3x1 3x1 Maintenance of these links is important in the prevention and control of 3x1 3x1 Sept 2014, DPH, National Incident/Outbreak communicable disease, including maintenance of an ongoing ABUHB immunisation Control plans, and has a strategy and plan through the Gwent Immunisation Group. Review: April 2017 multisdisciplinary 'Gwent Immunisation Group' which meets regularly. They are also

represented on the multiagency Infectious Diseases subgroup of

the Gwent Local Resilience Forum. 14 2.1 6. We fail to have systems and plans to prevent and control communicable disease outbreaks and provide immunisation Tab 2.1 Risk Register

Public Health and Partnerships Committee Risk Register 9/07/2015

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(iii)The Health Board maintains Transition of provision of routine childhood vaccinations from Health Visiting 2x3 2x3 The Health Board’s performance for uptake of immunisation at age 2 years has been 1x3 1x3 December 2016, a Childhood immunisation Service to General Practice has been implemented. Health Visiting will continue high, with the 95% target being consistently met. Over 2016 approximately 82% of DPH & Div FT & programme, and an Influenza to provide vaccination to children of 'hard to reach' families who repeatedly fail children aged four are up to date with all their immunisations. However, it should be Div PCN, immunisation programme for to attend in Primary Care. noted that uptake rates by age 5 increases to above 90% for all immunisations. Review:

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public staff and specific patients A Health Visiting immunisation team is being recruited by the Health Board and An action plan was developed and implemented to deliver improvements in the Review: April 2017 General Practices have been offered a choice of undertaking their own childhood percentage of children aged 4 who are up to date with all their immunisations. vaccinations or commissioning the Health Visiting Immunusation Team to vaccinate their childhood population. Uptake of MMR1 by age 2 reached 95% in three of the five Local Authority areas in ABUHB. Work has been ongoing to increase capacity for childhood immunisation. Uptake of MMR2 at the age of 4 years is lower, but in line with the Wales uptake rate.

By age 5, uptake of MMR2 has increased to levels in line with Wales, in all Local Authority areas except for Newport.

Percentage of resident children reaching their 4th birthday who are up to date with all scheduled immunisations in 2016 falls below the Wales rate, although the rate varied across NCNs for the year from 85.9% to 75.4%.

There has been ongoing work to address both the queues and a transition in the delivery of the programme to a service delivered in the main via GP services rather than Health Visiting services. Training was completed in September 2016 and GP practices are being supported to ensure they allocate adequate resources to deliver the programme.

The Family & Therapy Services Division and Respiratory Directorate are meeting to develop a plan for BCG vaccination needed for targeted groups.

iv) ABUHB currently has a part The IC remains on a 30 week contract, with a job description aligned to the 3x4 3x4 Deputisation arrangements to cover key components of the IC role need to be agreed 3x4 3x5 February 2015, time Immunisations Co- National Standard for a full time IC. No formal deputisation arranged for the key to ensure business continuity if the IC is absent For example, training, professional DPH & Div FT & ordinator employed with Family parts of the role exist. A part time administrative post is funded to support the IC advice to vaccinators (where queries fall outside of Green book guidance), input to the Div PCN, & Therapies Directorate. role. However, there remains limited resource to support ongoing immunisation WG Welsh Immunisation Group etc. Two immunisation support workers have been across the Health Board, which presents a real risk to business continuity and to employed to support training and provide suppport to the IC. Review: April 2018 vacination uptake rates.

17 of 147 17 15 2.1 6. We fail to have systems and plans to prevent and control communicable disease outbreaks and provide immunisation 18 of 147 18 Tab 2.1 Risk Register

Public Health and Partnerships Committee Risk Register 9/07/2015

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v) The Child Health System Inaccurate data in the CHS means much time is wasted pursuing children who 3x3 3x4 More resource into the running of the CHS register could support more accurate(and 3x3 3x4 January 2015, (CHS) is vital to provide timely have already had vaccinations, and also potentially adversely affects relationships probably higher) vaccination rates, and allow staff to concentrate on children who DPH, information in the event of an between NHS staff and families. Time and effort is also wasted in answering really were unvaccinated, thereby potentially removing risks form vaccine preventable outbreak of disease preventable questions and explaining possible reasons for a perceived rather than a real disease in the population - this is being discussed. GP pracitices have been given read Review: April 2017

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public by routine childhood problem. More importantly, confusion over data takes staff away from seeking only access to the CHS to view immunisation status of children registered at their vaccinations, but is dependent out and vaccinating those children who are not protected. practice. Regular electronic updates directly from LEAs has been agreed with all Local upon a single officer for Authorities, and action to regularly cleanse the data is underway. maintenance and oversight.

vi) Increase the level of A number of NCNs included flu vaccination into their plans and have taken a Maintain position as leading Welsh Health Board performance on influenza influenza vaccine uptake in all more organised approach to delivery particularly to patient groups at high risk, immunisation for over 65 year olds and those in at risk groups, with increasing at risk groups at NCN level and for example those in residential homes, who are at increased risk of performance on uptake by pregnant women and children by reducing variance in NCN reduce the gap across all complications of flu if they get it, but also at increased risk of exposure due to planned implementation and working with a range of community partners. ABUHB NCNs. their accommodation. NCN wide plans also incorporate timely vaccination of pregnant women.

Plans were implemented with varying fidelity and outcomes. Data were fed back and reviewed at NCN level on a regular basis throughout the season. As a Health Board ABUHB uptake rate for people ages 6 months to 64 year ‘at risk’ was 49.8%, which is the highest in Wales and compared favourably to the Wales rate of 46.7%

ABUHB uptake of influenza vaccination as of 7/3/2017 was 68.1% for those aged 65 years and above, compared to the Wales uptake of 66.6%

ABUHB uptake rate for people ages 6 months to 64 year ‘at risk’ was 49.8%, which is the highest in Wales and compared favourably to the Wales rate of 46.7%.This rate is slightly lower than last year, since the denominator data

viii) Flu vaccination for children Full implementation of this new programme is likely to contribute to the 3x3 3x4 Some funding is available with the new programme, and staff are considering 3x2 3x4 June 2015, DPH

is being extended to those in disruption of the spread of flu viruses in the community, but this is going to place requirements. and Div F&T reception, year 1, 2, 3 and year a considerable extra burden on the school nursing service, which could jeopardise

4 in primary schools from other important public health fucntions that they currently perform. Review: Dec 2017 Autumn 2017. 16 2.1 6. We fail to have systems and plans to prevent and control communicable disease outbreaks and provide immunisation Tab 2.1 Risk Register

Public Health and Partnerships Committee Risk Register 9/07/2015

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ix) uptake of all scheduled This appears to be an issue with the timeliness of vaccination delivery, which is of 3x3 3x4 Additional staffing is being requested by the relevant departments, and the 3x3 3x4 June 2016, DPH, vaccination by age four concern as it leaves many children unprotected during their first year of full time immunisation co-ordinator role is being reconsidered to free up time to support teams Div F&T, Div PCN continues to fall. schooling. and practices. An action plan to reduce waiting times / queues is being implemented to ensure children are offered the vaccination on a timely basis. Review: April 2018

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public The World Health Organisation has reported a sharp increase in the incidence of Measles cases in the Europe Region in 2017. Larger outbreaks have occurred in areas where immunisation rates fall below the 95%, which give community immunity and prevent the transmission of measles within a population.

7. We fail to provide (i)The Health Board supports Overall uptake rates in ABUHB are generally meeting or close to meeting targets, 2x3 2x4 Cancer screening uptake will also be encouraged through the 'Living Well Living 2x3 2x4 DPH effective the Public Health Wales with the exception of Bowel Cancer and Aneurysm Screening. Within ABUHB Longer' inequality reduction programme in the most deprived areas - this may help to programmes to national screening programmes however, there are inequalities with uptake rates being lower in the more address the reduced screening uptake in most deprived areas. Awareness Review: October screen and detect for cervical, breast and bowel deprived areas. It is likely that there are other inequalities by population raising/encouragement by GP practices and other partners should help to increase 2017 disease cancer etc. via various SLAs. subgroups - eg ethnic minority - but data are not available. uptake. We need more detailed information from Screening Service to help identify particular populations requiring targeting.

19 of 147 19 17 2.1 20 of 147 20 Tab 2.1 Risk Register

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(ii)The 'Living Well Living Over 11,700 citizens have attended a full Health Check with 1,746 sessions held in 2x3 2x4 Complete the roll out of the Living Well Living Longer Programme. In Torfaen North 2x3 2x4 DPH Longer' programme is offering 57 local community venues across 6 cluster areas and 39 GP practices. All invite letters have been sent to all practices, in Newport East invite letters have been targeted health checks for attendees have had the full range of tests, advice and brief interventions offered. sent to 4 out of 7 practices and Newport West NCNs a CPD session for the 5 practices Review: October cardiovascular disease and risk was held on 28/9/17. 2017

Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public factors across the most The Well Being Advisor Service is a new development, receiving over 400 deprived communities of referrals so far, which supports high risk patients for a period of up to six months, Implement a sustainable, social model of primary care to support people to reduce ABUHB. This has the potential to understand their modifiable risks and to set goals and actions which will help their risk of heart disease, stroke, diabetes, cancer, respiratory and liver disease in to make a significant difference to lower their risks. Blaenau Gwent West, Blaenau Gwent East and Caerphilly North NCNs. to inequalities in healthy life expectancy in ABUHB. In terms of clinical intervention, around 30% of patients exceeded NICE threshold Implement a mental wellbeing pathway as part of the Living Well Living Longer requiring a further appointment with their GP Practice in relation to blood programme. pressure, cholesterol and diabetes risk. An initial evaluation of the programme is currently taking place (August 2017). Working with community partners through NCNs, implement an Integrated Wellbeing Network as part of the Living Well Living Longer programme. Support is also provided to people to reduce their preventable risk factors for cancer through the Living Well, Living Longer Programme (as set out above). The Through NCNs, identify and disseminate the common themes from the 2016/17 GP national screening programmes are promoted through the Health Check. Practice audit of new cases of cancer.

GP practices have carried out their significant event analyses of lung, digestive and ovarian cancers.

NCNs have also concluded evaluation of the bowel screening pilots. 18 2.1 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

PPWBC 9th November 2017 2.2 Agenda Item:

ANEURIN BEVAN UNIVERSITY HEALTH BOARD’S PLAN FOR A PRIMARY CARE SERVICE FOR WALES UP TO MARCH 2018

Purpose of the Report:

The purpose of this report is to update the Public Partnerships and Wellbeing Committee of the Divisional progress in taking forward the broad components of the Primary Care Plan for Wales.

Recommendation:

The Committee is asked to:  Note the action plan and the Divisional assessment of the progress being made  Comment on the validity of the ratings set

The Committee is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance X Note the Report for Information Only Executive Sponsor: Nick Wood – Chief Operating Officer Report Author: Sian Millar, Divisional Director of Primary Care and Community Services Report Received consideration and supported by :

Executive Committee of the Board Team [Committee Name] Date of the Report: 12 October 2017 Supplementary Papers Attached: Appendix 1 ‘RAG Rated’ Action Plan

2 Background

The Public Partnerships and Wellbeing Committee will be aware of the recently constituted National Primary Care Board for Wales and also of the Directors of Primary Care, Community and Mental Health Peer Group which is an all Wales Forum. The agenda for this latter group is very much focused on the actions required to meet the objectives of the

Public Partnerships and Well Being Committee-09/11/17 21 of 147 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

PPWBC 9th November 2017 2.2 Agenda Item:

Primary Care Plan for Wales up to 2018 and its accompanying workforce plan. This is now reported to the National Board

Through the Directors Peer Group noted above, Welsh Government has articulated the main components of the Primary Care Plan and received progress reports from individual Health Boards through regular monthly telephone briefings with the Director of Primary Care.

3 Progress with the Plan

Attached is the Plan noting key actions, a ‘self-assessment’ rating for performance from 2015 – 2017 and a brief commentary. The Committee will note that the areas designated as ‘red’ are:

o To establish a rolling programme of peer review for Primary Care. This is ‘red’ because a national framework for such a review is awaited. o To establish a shared IT system between Health, Local Authorities and the 3rd sector. This is ‘red’ because the WCCIS rollout is nationally driven and the Health Board is not yet connected. The Division participates in the programme structure established to oversee WCCIS implementation. It should be noted there are no plans to include Primary Care information as yet.

There are also 2 ‘amber’ actions, as reported in 2017:

o The establishment of patient participation mechanisms – this is ‘amber’ because although there are a number of valuable initiatives, the Division has not yet established a more formal framework. The Division, in partnership with the Public Engagement Service within the Health Board, has commissioned an Asset Based Community Development workshop to be held with partners and which should facilitate the development of such a framework. o The identification of solution through the IMTP, to tackle inequalities in health and to improve access for all groups regardless of language, culture or disability and frailty. This is ‘amber’ because the Division considers this of paramount importance and it is a broad and complex objective.

22 of 147 Public Partnerships and Well Being Committee-09/11/17 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

PPWBC 9th November 2017 2.2 Agenda Item:

We note the progress being made in service model transformation through such developments as Living Well Living Longer and the Older Persons Pathway and note the Division has a Welsh Language Plan. The newly formed Gwent Adult Services Partnership will help to drive improvement for all adults with physical and sensory needs.

4 Recommendation

The Public Partnerships and Wellbeing Committee is asked to note the action plan and the Divisional assessment of the progress being made and, to comment on the validity of the ratings set.

rows

Public Partnerships and Well Being Committee-09/11/17 23 of 147 24 of 147 24 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

Key to RAG Rating Background Format Red Below plan will not be delivered within agreed timeframes Amber Almost on plan confident actions can be delivered within agreed timeframes Green On plan or better to deliver actions within agreed timeframes Blue Action complete

Key Actions Period Performance Commentary/Migating Movement 2017 2016 2015 Actions Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public 1 Health Boards will support GP practices to collaborate at cluster level Each year,  Wider Network established to develop and deliver an action plan with specific goals and actions from 2014- in Gwent since 2011 for developing and improving GP services and local solutions to help 15  NCN Plans are developed deliver sustainable and improved local health and well being, reduced by the wider network and health inequalities and improved service quality and performance. feed the IMTP – Three Year Plan 2 Health Boards will support their primary care cluster to:  Directory of services  Implement actions and key milestones to support their almost complete in line sustainable rapid ongoing development. with 111 implementation  Undertake an assessment of local health and wellbeing needs, drawing on a wide range of sources of information.  Map all available clinical, workforce and other resources and  An integrated health and communicate this to both the local population and those social care strategy has providing these services, particularly those services been produced for formal responsible for coordinating people’s access to services. sign-off in September and steered by the Greater Gwent Partnership Board

 Agree protocols for access to all available services; use an Each year,  Access work streams assessment of how clinical, innovatively and identify what from 2014- gaps in services and workforce numbers and skills remain to 15 direct the better use of all available resources.  Put in place local pathways of care and referral protocols for accessing these services, workforce and other resources appropriately.  Ensure that these local pathways of care and referral  Principles for Access protocols are capture in a robustly managed, maintained and agreed with the LMC up to date directory of service to ensure that local clinicians  A number of pathways are and the public know what is available and how they can in place eg diabetes, access it easily, and this is made available to the national respiratory et al – a clinical 111 services as it is rolled out across Wales. reference group will guide  Develop and deliver a three year plan, informed by the the further pathway

cluster level plan for GP services with specific goals and developments

2.2 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

Key Actions Period Performance Commentary/Migating Movement 2017 2016 2015 Actions

actions for developing and improving primary care services  Level 1 clinical futures plan to deliver improved local health and wellbeing, reduced in development health inequalities and improved service quality and  Health and social care performance. assessments undertaken for SSWB Act and Future Generations Act 3 Health Boards will support their primary care clusters to draw in al From Section 33 Integrated local partners, such as the third sector and local government to 2015-16 Frailty Services across Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public deliver local solutions and strategies to improve health and wellbeing Gwent of the local community, help prevent avoidable ill health and provide Integrated Health and ongoing care for people living with long term conditions or who are Social Care Strategy frail and elderly. developed under Collaborative Network 4 Health Boards will support primary care clusters to establish patient From Patient Engagement Street participation mechanisms and to demonstrate how they are actively 2015-16 Events seeking and responding to people’s experience of all aspects of Patient Experience primary care to drive and report on continuous improvement in the MOS/ODTC OAKnee quality of care for their communities. Expert Patient Groups Citizen Panels 5 Health Boards will support their primary care clusters, to introduce a From No framework for core rolling programme of peer review for primary care, based on a set of 2016-17 principles in place across Wales nationally agreed core principles which health board directors of primary, community and mental health help develop to drive and report on continuous improvement in the quality of care. 6 Health Boards, through their annual refresh of their three-year Each LWLL Programme integrated medium term plans, informed by cluster level plans will set January Older Persons Pathway, specific goals and actions at cluster level to: Newport  Identify local solutions and use primary care to meet local Older Persons Partnership need, tackling the inverse care law and reduce inequalities in Board health outcomes; Welsh Language plan in place  Improve access to primary care for people with Welsh  Integrated Strategy – local Language or other language and cultural needs, people with plan been developed, led physical and learning disabilities, people with sensory loss, by NCNs. The plan uses people with low health literacy, frail older people and those the NCN footprint as the who do not routinely seek help from the NHS. focus and ‘place’ of care.

Local Health Board Actions 7 Health Boards will work with primary care to identify people at With Diabetes Enhanced Services increased risk of poor health or exacerbations of existing conditions immediate Care Plans and manage that risk through an agreed individual care plan, with a effect

25 of 147 25 2.2 26 of 147 26 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

Key Actions Period Performance Commentary/Migating Movement 2017 2016 2015 Actions

named care co-ordinator where appropriate and agreed with the Primary Care Diabetes individual to oversee that care. Specialist Nurses ACP in Care Homes Stay Well Plan, Older Peoples Partnership, Newport 8 Health Boards will, explicitly reflect their primary care clusters’ three- Each year plans in the annual refresh of health board level three year January integrated medium term plans. Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public 9 Health Boards should consider and develop joint contracting From 3rd Sector SLAs arrangements with multiple service providers, including local 2015-2018 Section 33 Frailty authorities’, the third and independent sectors. (NPCN (2014) pp 13) 10 Health Boards will work with local authorities, the third sector and From others to begin to phase in a national online and telephone service October call 111 to provide access to a wide range of reliable health and 2015 wellbeing information, advice and assistance. 11 Health Boards, local authorities, the third and independent sectors From WCCIS Pilot in one Local will begin using a shared IT system to collect and share information 2015-16 Authority to support primary care. No Primary Care systems included One Borough not yet signed up to WCCIS.

12 Health Boards will encourage use of Add to Your Life and My Health From ABUHB performs well re MHOL Online by their local populations. (NPCN (2017) pp 13) 2015-2018 13 Health Boards will, through their annual refresh of their three year Each  5 As for Access integrated medium term plans, informed by cluster level plans, January demonstrate how they will provide increased capacity and a growing  MHOL range of primary care close to home, including:  Access Enhanced Services  Access for working people to see or speak to GP services in  Demand/Capacity work in the evening and on a Saturday morning: Diagnostic tests; practices  Local professionals trained to prescribe medicated Multi disciplinary workforce treatment; Services to support healthy lifestyles, self care,  response rehabilitation, reablement, episodes of acute care and end of life care with dying in people’s preferred place of care. 14 Health Boards will agree with Welsh Ambulance Service how From  FARS paramedics can help to deliver care at home and in the community 2015-2018  Paramedics – In hours (NPCN (2014) pp 14)  Paramedics – Out of Hours 15 Health Boards will optimise the Dye Health Examination Wales From (EHEW) service to provide the majority of care closer to home. (NPCN 2015-2018 (2014) pp 14)

2.2 Tab 2.2 Plan for a Primary Care Service for Wales up to March 2018

Key Actions Period Performance Commentary/Migating Movement 2017 2016 2015 Actions 16 Health Boards will also continue working with all services and From Planned use of enhanced practices in primary care including community pharmacists, dentists 2015-2018 services – Community and optometrists on opening times. (NPCN (2014) pp 15) Pharmacies - MOS - ODTC 17 Health Boards need to plan, educate and train a more flexible local From  Primary Care Nursing healthcare workforce and develop the potential role of AHPs, which 2015-2018 framework and plan requires priority being given to their education and training. (NPCN  Pharmacists, Social Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public (2014) pp 15) Workers, social prescribing therapists in Practice teams 18 Health Boards will work with their partners and service providers to From Social prescribing develop more ways for people to access medication, treatment and 2015-2018 Practice based Pharmacists information, advice and assistance in using and managing their Enhanced Services Plan medication in the best way. (NPCN (2014) pp 20) 19 From April 2015, health boards will use the agreed national set of From April Participated in Measures, primary care quality and delivery requirements and measures, 2015 development and presented to developed by Health Board Directors of Primary, Community and Board. Mental Health by December 2014, developed further by December Informed own measures 2015 to drive and report on continuous improvement in the quality of care. (NPCN (2014) pp 15)

27 of 147 27 2.2 Tab 2.3 Primary Care Annual Report - For Information

PPWBC 9th November 2017 2.3

Aneurin Bevan University Health Board

Primary Care Annual Report 2016/2017

Purpose of the Report:

The purpose of this report is to provide the Public Partnerships and Wellbeing Committee with the Primary Care Annual Report for 2016/17.

This includes key developments for all Independent Contractors: General Medical Services, General Dental Services, Community Pharmacy and General Optometry Services. The report also identifies priorities for 2017/18.

Recommendation:

The content of this report is to be noted.

The Board is asked to: (please tick as appropriate) Approve the Report Discuss and Provide Views Receive the Report for Assurance/Compliance Note the Report for Information Only X Executive Sponsor: Nick Wood, Chief Operating Officer Report Author: Victoria Taylor, Head of Primary Care Report Received consideration and supported by:

Executive Committee of the Board Team [Committee Name] Date of the Report: 6 October 2017 Supplementary Papers Attached: Primary Care Team Annual Report 2016/17

Introduction

Aneurin Bevan University Health Board has to ensure that the provision of services provided by Independent Contractors reflects the needs of the Health Board’s population. 90% of all patient interventions take place within primary care. These services are valued by the local communities and their role in meeting patient needs is paramount. Historically, General Practitioners have been the first point of entry to the health care system and deliver care for the majority of conditions, however, increasingly the other contractor professions are delivering urgent and planned care as a first point of contact.

The importance of the delivery of effective Primary Care services impacts on many statutory functions and services provided by the Health Board. 1

28 of 147 Public Partnerships and Well Being Committee-09/11/17 Tab 2.3 Primary Care Annual Report - For Information

PPWBC 9th November 2017 2.3

Primary Care Annual Report 2016/2017

The report focuses on the performance and service delivery of Independent Contractors during 2016/2017.

Quality and Outcomes Framework 2016/17

The Quality and Outcomes Framework provides information in relation to a wide range of clinical indicators, providing a measure to evaluate the consistency of clinical care. This attracts additional income for practices. During 2016/17 practices received £7,845,800 an increase of £155,894 on 2015/2016.

In January 2017 Welsh Government and GPC Wales announced that effective immediately, the Quality and Outcomes Framework (QOF) element of the GP contract would be relaxed until 31 March 2017. The aim of the relaxation of QOF was to free up more capacity for GPs and practice nurses to manage their most vulnerable and chronically sick patients during the winter period. Whilst the actual amount of time freed up for GPs and practice nurses as a result of relaxing QOF would be difficult to quantify, Welsh Government and GPC Wales were confident this initiative would help GPs and practice nurses at a time when they are at their busiest.

Of the 567 total QOF points available, GP practices were be able to opt out of over 75% of the total points. The average number of points achieved across the 12 NCN clusters ranged from 459.30 in Blaenau Gwent to 563.64 in Newport.

Access to Primary Care Services

General Medical Services

Improving access to General Medical Services has been a priority and has resulted in the Health Board launching the first Access Accreditation System in Wales. The Accreditation System is based on achievement of five standards for which practices are awarded an A rating for each standard they meet.

When the system was launched in January 2012, there were 26 practices achieving the 5A standards. The scheme has been widely reported in the media both locally and nationally and has been adopted as good practice. As a result of this initiative the number of practices meeting 5As now stands at 62 (77.5% of GP Practices).

To further enhance this access initiative, an Extended Hours Local Enhanced Service was introduced and offered to those practices achieving 5A status. There are currently 36 practices commissioned to deliver this enhanced service providing an additional 83 clinical hours per week outside of core hours (8.00am – 6.30pm).

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Access Quality Improvement Scheme – funded by Welsh Government Primary Care Pacesetter monies. This scheme was developed to identify and understand the existing demand and supply for GMS services and to work with practices to develop improvement plans to optimise access. 47 practices participated in this initiative which required them to undertake a full and comprehensive review of their patient accessibility in order to develop a robust plan. Following their review, practices were funded by the Health Board to purchase specific interventions to improve and optimise access for patients. These included new telephony and booking systems and software packages to improve triage and implement telephone consultations.

In addition, a further six practices worked with an external provider, Operasee, to assess the impact on practice work/patient experience using LEAN methodologies. More detail is available in the full report.

My Health On Line - is a web based appointment system that allows patients to book appointments and order repeat prescriptions with their GP Practice 24 hours a day.

As at July 2017, 100% of practices in ABUHB have the ability to offer patients within their practice the option to sign up to access the MHOL system, with 80% using the system to allow patients to pre-book appointments and 99% using for repeat prescription requests. ABUHB currently has over 52,000 patients who have signed up to use the MHOL system. The Health Board is committed to continuing to promote the use of My Health On Line and increase the number of GP practices offering this facility for appointments and prescriptions.

General/Personal Dental Services

The Health Board has continually monitored Dental Practices to identify the current capacity to accept new National Health Service patients.

In June 2016/17, the Division acquired £175,000.00 from Welsh Government to invest in ‘high street’ dental practices. Therefore, the Division invested in 13 Personal Dental Service contracts with a view that an increasing number of ‘new patients’ (not seen in the last 24 months) would be able to gain access to a dental practice. The 13 new contracts implemented resulted in 1,563 new patients being treated.

The Division continues to recognise the access issues and has invested an additional £75,000.00 to increase dental access. Therefore, six Personal Dental Service contracts have been established totalling £250,000.00 additional spend.

The Division has received a further £300,000.00 in 2017/18 from Welsh Government to address the access issues. The Primary Care Team is currently tendering for this service in order to target the areas in highest need/demand for dental services.

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In 2016/17 the Division invested an additional £84,000.00 in to orthodontic services which allowed for 60 new patients to be assessed and treatment started.

The Health Board increased the minor oral surgery contract values by £209,000.00 during 2016/17 to reflect the level of need for the service. The overall budget for this service is £502,000.00.

The Health Board will be:

 Undertaking a review of sedation services to ensure there is equitable service provision in line with regulations.  Re-tendering for a General Dental Practitioner Domiciliary service.

Community Pharmacy Services

The table below provides a summary of weekend and late night access.

Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent Number of pharmacy 16 43 18 32 21 130 premises Number open on 13 31 17 22 13 96 Saturdays Number open on 0 1 2 4 1 8 Sundays Sunday Rotas 4 5 1 6 7 23

General Ophthalmic Services

The table below highlights the number of practices providing services:

General Mobile General Wales Eye Wales Low Glaucoma Local Optical Optical Local Care Vision Enhanced Services Enhanced Service Services Service Service Blaenau Gwent 8 3 8 7 1 Caerphilly 20 5 19 13 1 Monmouthshire 15 2 11 6 1 Newport 15 3 12 5 2

Torfaen 10 2 10 4 1

Total 68 15 60 35 6

Enhanced Services

The full details of current enhanced services are included in the report.

The following new Enhanced Services were introduced in General Practice in 2016/17 with the programmes of work forming part of the National Pacesetter Programme and funded in part via new primary care monies:

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Primary Care Anticoagulation Service: an agreement was reached with the Gwent Local Medical Committee to develop an interim Local Enhanced Service (LES) which will be replaced with the All Wales DES when available.

The interim LES was finalised and issued to practices in January 2017. The service specification enables practices to provide the full point of care and dosing service (currently Level 4).

Primary Care Nurse Led Childhood Immunisation Team: The Health Board determined that in order to maximise vaccine uptake, and ensure all practices were treated equitably, that all practices should be required to take responsibility for delivering this service.

Dedicated funding was provided to practices to recognise the complexities in providing this service.

Those practices that did not provide the service were offered the opportunity to purchase this from the Health Board’s Family and Therapies Childhood Immunisation Team. 10 practices chose this option.

There have also been a range of enhanced services changes during the year across all the contractor professions:

Violent Patients: Provides a safe haven GMS service to patients who have been removed from their general practice. The provider practice and Gwent Police SLAs have been reviewed and updated during 2016-17.

Primary Care Anticoagulation Service: Significant work has been undertaken in respect of this enhanced service to shift services from Secondary Care in to Primary Care during 2016/17.A total of 69 practices indicated that they wished to provide services to their patients from their practice premises. During 2016/17, 14 practices provided patients with this service. The remaining practices will “go-live” during 2017/18 on a phased basis. Care Homes Local Enhanced Service: This Local Enhanced Service allows General Practitioners to take a proactive approach to caring for registered patients currently living in care homes. The National review that was ongoing during 2016/17 concluded at the end of the year and culminated with the introduction of a new DES which will be rolled out to practices in 2017/18. Denosumab Local Enhanced Service: To treat patients at risk of pathological fractures due to osteoporosis. During 2016/17, this enhanced service was amended to include the treatment of men.

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Community Pharmacy

The Health Board commissions a number of Enhanced Services to improve health outcomes, access to services locally and ensure equity.

The table below illustrates the number of community pharmacies commissioned to provide the enhanced service per locality:

Local Enhanced Services Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent Supervised Administration of 11 25 14 26 15 91 Medicines

Service Specification Do not Do not Do not Do not requirements for commission commission commission this 3 commission 3 Directly Observed this service this service service this service Therapy

NES Pack Service 4 3 3 1 3 14 NES Pick and Mix 1 1 1 1 1 5 Service Waste Reduction 6 10 8 22 8 54 Service Medicines Do not Do not Administration 5 25 11 commission commission 41 Record Service this service this service

Smoking Cessation 10 22 10 22 12 76 Services-Level 2

Smoking Cessation 7 18 8 14 13 60 Services-Level 3

Pilot PGD Smoking Do not Cessation Level 3 4 3 2 commission 1 10 Service this service

Smoking Reward 1 4 2 3 1 11 Scheme

Palliative Care Out of Hours Rota 1 4 2 3 1 11 Service Out of Hours Rota 13 22 8 12 12 67 Service Do not Do not Do not Newport Additional commission commission commission this 6 0 6 Sunday Rota this service this service service Do not Do not Do not Do not Minor Ailment - commission commission commission this commission 21 21 Torfaen Borough this service this service service this service

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Medication Do not Do not Do not Administration commission commission commission this 15 20 35 Service this service this service service

Out of Hours Emergency Supply N/A 1 1 3 1 6 of prescribed medication

Pilot- Asthma Review Jan-Mar 1 1 1 1 1 5 2016

National Enhanced Services

Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent

Just in Case 7 21 9 17 14 68 Scheme Emergency Hormonal 14 30 11 26 15 96 Contraception Flu Vaccination 9 23 9 21 14 76 Scheme

The Health Board will be working with community pharmacies to:

 Increase the uptake of enhanced services.  increase the number of community pharmacies providing Flu Vaccination Service Local Enhanced Service from 70 to 100.  Implement the Choose Pharmacy Platform including Common Ailment Service with community pharmacies throughout all localities within the Health Board as part of a rolling programme in collaboration with NWIS with Hub pharmacies.  Increase activity for the smoking cessation Level 3 service to meet the Tier 1 target.

General Ophthalmic Services

The aim of the Mobile Sight Tests in Hospitals Local Enhanced Service is to enable contractors and assistants listed to provide Mobile General Ophthalmic Services to provide sight tests to hospital in-patients which enables patients who are effectively residents in Aneurin Bevan University Health Board hospitals to have access to primary eye care services.

The Health Board will be working with ophthalmic service providers to develop services at cluster level with NCN lead.

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Workforce Issues

The Division has conducted a detailed assessment of the General Practitioner profile across the Health Board. This demonstrates that between 2015 and 2020 there are likely to be significant recruitment issues, which reflects the national position. It is increasingly becoming more difficult to recruit to General Practitioner posts, which is a major concern. This is acknowledged nationally and the Health Board will continue to work with Welsh Government to address this.

Similarly, there are issues relating to Practice Nurses due to their changing role within General Practice and the development of Nurse Practitioners and HealthCare Support Workers. This too will require collaboration with the Health education and Improvement Wales to address the educational requirements for these roles.

Sustainability

As part of the GMS Contract negotiations for 2016-17 an agreement was made to develop a framework for assessing the sustainability of GP practices due to the impact of a number of external factors which may impinge on the sustainability of a contracted GP practice.

The GP Sustainability Framework was issued by Welsh Government to assist Health Boards to identify practices at risk of having to reduce service provision and/or to give notice to terminate their GMS Contract and offer targeted support. Practices are able to apply for support from the Health Board to stabilise service provision. Five applications were received and considered during 2016-17.

The division also delivered six sustainability workshops across the Health Board.

A number of Vacant Practice Panels (VPPs) have been held where practices have decided to hand back their contracts to the Health Board, securing the ongoing care for patients within Aneurin Bevan Health Board.

The Health Board retained responsibility for a directly managed practice Blaen– y-Cwm Surgery in Blaenau Gwent.

Three branch surgery closures were considered and agreed during 2016/17.

15 boundary reviews were supported and agreed during 2016/17.

Primary Care Estate

Ensuring there is capacity within Primary Care Estate continues to be a challenge and improving capacity in Primary Care estates is fundamental to the delivery of the primary care agenda.

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During the year work commenced on site for the Brynmawr Resource Centre and a Third Party Developer was appointed for the Llanbradach Primary Care Centre. In addition, a multi-agency group has been established and initial discussions are underway with regards to developing an appropriate service model for the Tredegar area and ultimately the Tredegar Health and Well-being Centre and proposals are being developed for the Newport East Resource Centre. 24 practices were supported to improve premises via Improvement Grant Funding as at total cost of £375,775.

Store & Scan: the Patient Medical Record Storage and Scan Service provides off-site secure storage and management of live patient medical records. This is for all GP practices within Wales and is run in partnership with NHS Wales Shared Services Partnership. The scheme commenced in January 2017 and will be rolled out to all ABUHB practices on a phased basis over a one year period, with an estimated completion of December 2017.

Conclusion

The 2016/2017 Primary Care Report incorporates the four Independent Contractor services; General Medical Services, General Dental Services, Community Pharmacy and General Optometry Services. The report gives an overview of the delivery of services and developments during 2016/17.

Recommendation

The Committee is asked to note the Health Board’s Primary Care Annual Report for 2016/17.

Assessment of the Impact of the Report: Financial Financial arrangements are set out within the Assessment contractual frameworks. The Health Board’s allocation for General Medical Service is ring fenced.

Link to Integrated Service developments are identified within the IMTP. Medium Term Plan The annual report provides details regarding the contractual and statutory requirements. Risk Assessment There are risks to the Health Board if the Independent Contractors’ contractual issues are not appropriately managed as there could be potential clinical, financial and service implications. Quality, Safety and Effective delivery of Independent Contractor Services Patient Experience impacts on all aspects of quality, safety and patient Assessment experience. Health and Care Effective delivery of Independent Contractor Services Standards will contribute to the Health Board’s implementation of all standards Equality and This has not been undertaken during the production Diversity Impact of this report.

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Assessment (including child impact assessment)

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2.3

Aneurin Bevan University Health Board

Primary Care Team Annual Report

2016/2017

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2.3 CONTENTS

1 Introduction 4 1.1 Highlights from 2016/17 4

2 General Medical Services 8 2.1 Strategic Context 8 2.2 Practice Profiles 8 2.3 Sustainability 8 2.4 General Practitioner Workforce 11 2.5 Vacant Practice 12 2.6 Branch Surgery Closures 13 2.7 Boundary Reviews 14 2.8 Access to General Medical Services 15 2.9 Extended Access 18 2.10 Optimising Access in General Practice 18 2.11 Access Quality Improvement Scheme 19 2.12 My Health on Line 21 2.13 Incentives 22 2.14 Quality and Outcomes Framework 22 2.15 Enhanced Services 25 2.16 Contractual Governance and Assurance 33

3 General Dental Services 35 3.1 Strategic Context 35 3.2 Practice Profile 35 3.3 Governance Arrangements in General Dental 35 Services 3.4 Annual and Quarterly Review Process 36 3.5 General/Personal Dental Services 38 3.6 Orthodontic Dental Services 39 3.7 Domiciliary Dental Care 40 3.8 Commissioning of Occupational Health Service 41 3.9 Minor Oral Surgery Service 41 3.10 Sedation Services 43 3.11 Local Oral Health Plan 43 3.12 Bariatric Chair Access 43 3.13 Restorative Service 44 3.14 COMPASS 44

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2.3 4 Community Pharmacy Services 45 4.1 Strategic Context 45 4.2 Operational Context 45 4.3 Governance Arrangements in Community 45 Pharmacy Services 4.4 Access to Community Pharmacy Services 49 4.5 Enhanced Services 49 4.6 Markham 55

5 Community Optometry Services 56 5.1 Strategic and Operational Context 56 5.2 Optometry Governance Structure 57 5.3 Access to Optometry Services 57

6 Primary Care Estates 59 6.1 Schemes 59 6.2 Improvement Grants 59 6.3 Primary Care Investment Prioritisation Review 61 2015/16 6.4 Improvement Grants 2016/17 63

7 Primary Care Priorities 65 7.1 General Medical Services 65 7.2 General Dental Services 66 7.3 Community Pharmacy Services 67 7.4 General Optometry Services 67 7.5 Primary Care Estates 68

Appendix 1 Achievement against 2016/17 Primary 69 Care Objectives

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2.3 1 Introduction

The purpose of this report is to provide a summary of progress made against the priorities identified for 2016/17.

The report focuses on providing the Management Team with an overview of developments within the Primary Care Team, including the four independent contractor professions who provide General Medical Services, General Dental Services, Community Pharmacy and Community Optometry. It also sets out the primary care priorities for 2017/18.

1.1 Highlights from 2016/17 The Primary Care Team identified a number of priorities for 2016/17 within the 2015/16 Primary Care Annual Report, progress against these priorities are set out in Appendix 1 attached.

Throughout 2016/17, there has been significant progress with regard to developments within Primary Care which are highlighted below, the independent contractor developments are described in more detail later in this report.

1.1.2 General Medical Services  Implementation of the sustainability framework with five applications considered  Series of six facilitated Sustainability Workshops  Delivery of services within Managed Practices  Expansion of Primary Care Operational Support Team  The Health Board continues to commission a range of Enhanced Services to deliver additional services in general practice.  Continuation of the minor skin surgery enhanced service which was commissioned in 2015/16 funded by the new Welsh Government primary care monies  The anti coagulation service change implementation has been progressed throughout 2016/17  There continues to be an improvement in access to General Medical Services as a result of the continuation of the “A” is for Access scheme and an increase in practices providing the Extended Hours Local Enhanced Service.  Practices are promoting the My Health On Line (MHOL) service to patients and take up figures have increased during 2016/17.  Consistent governance arrangements remain in place to provide assurance around contractual arrangements and quality and patient safety issues.  The new 2016/17 Quality and Outcomes Framework indicators have been implemented.  A Continuous Professional Development programme for general practitioners and practice nurses has continued within Aneurin Bevan University Health Board.

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2.3  The Annual Review contract monitoring process continues and is supported by the Clinical Governance Practice Self Assessment Toolkit (CGPSAT).  The workforce profile of general practitioners has been reviewed and is continuously updated to ensure all changes are captured.  A number of Vacant Practice Panels (VPPs) have been held where practices have decided to hand back their contracts to the Health Board, securing the ongoing care for patients within Aneurin Bevan Health Board.  The Health Board retained responsibility for a directly managed practice “Blaen–y-Cwm Surgery” in Blaenau Gwent.  Three branch surgery closures were considered and agreed during 2016/17  15 boundary reviews were supported and agreed during 2016/17  The “Optimising Access” programme of work continues to progress with the implementation of the Access Quality Improvement Scheme which is part of the Welsh Government funded Pacesetters programme.  The team, supported by the Families and Therapies Division implemented a Childhood Immunisations scheme.

1.1.3 General Dental Services  Implementation of the integrated five year Local Oral Health Plan (LOHP) supported by the Board. This plan sets out the priorities for the Health Board for 2013-18 and focuses on prevention, education and treatment.  Continuation of a robust governance structure to ensure clinical leadership and provide assurance on contractual and clinical governance systems.  A consistent annual review process has been delivered which is fully compliant with the Public Health Wales ‘Model Dental Governance Framework for General Dental Services’ and ‘Delivering NHS Dental Services more Effectively’.  Additional investment within general dental access and orthodontic services  Continued engagement with Health Inspectorate Wales.  Continued monitoring of newly-commissioned Personal Dental Services Contracts.  The Primary Care Minor Oral Surgery Service continues to be a success.  The continued support of the Integrated Oral Health Strategy Group.  The Division continues to be actively involved in the South East Wales Managed Clinical Networks and the Health Board’s Integrated Oral Health Group.  An Occupational Health Service Level Agreement for all general dental providers continues to be commissioned.  The Division is actively involved in the 111 Urgent/Emergency Programme Board.  The Division is actively involved in the Contract Reform process.

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2.3

1.1.4 Community Pharmacy  Implementation of the Community Pharmacy Contract Monitoring Policy which included continuing a robust and consistent annual review process for all Community Pharmacy providers.  Annual review process supported by the clinical governance and information governance toolkits - 100% of community pharmacies comply with the contract in 2016/17.  Continued commissioning and implementation of Local and National Enhanced Services.  Implemented Medicine Use Review Telephone and Housebound Policy.  Implemented Discharge Medicine Review Housebound Policy.  Increased numbers of community pharmacies providing Level 3 smoking cessation service and activity by 65% for treated smokers and 70% for a four week quit rate.  Developed and implemented a reward smoking cessation scheme for community pharmacy contractors.  Implemented the Choose Pharmacy Platform and Common Ailment Service with Hub pharmacies.  Implemented additional Sunday rota in Newport to support and reduce the burden on GP OOHs over the weekend.  Developed a uniform service for the Medication Administration Service.  Increased the uptake of community pharmacies providing the Flu Vaccination Enhanced Service from 34 to 76 community pharmacies.  Implemented a pilot Smoking Cessation Level 3 PGD Varenciline scheme with ten community pharmacies.  Funding approved for the Medication Administration Enhanced Service.

1.1.5 General Optometry Services  Continue to monitor the Mobile Eye Sight Tests in hospitals Local Enhanced Service.  Commissioned six primary care optometry providers to deliver Glaucoma Ophthalmic Diagnostic and Treatment Centres to release capacity in hospital eye services throughout the Health Board area.  Commissioned a Wet Age-related Macular Degeneration Ophthalmic Diagnostic and Treatment Centre to refine referrals from primary care optometrists to promote achievement of the NICE 14 day referral to treatment target and increase capacity in treatment services, reducing demand for treatment on hospital sites.

1.1.6 Usk and Prescoed Prisons  General Practitioner and Pharmacy providers maintain service provision.  The optometry provider terminated his agreement with effect from 31st March 2017. The Division has since tendered and awarded the contract to a new provider

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2.3 1.1.7 GMS Estates  Completion of a wide range of both large and small Improvement Grants  Progression of the Brynmawr Resource Centre development.  Third Party Developer for Llanbradach appointed.  Review of all primary care developments and improvement grants against Welsh Government criteria and obtained Board approval for the identified priorities going forward.  Progressed Store and Scan

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2.3 2 General Medical Services

2.1 Strategic Context General Medical Practices provide the gateway to most National Health Services and strong primary care provision contributes to the effective and efficient use of health care resources. Approximately 90% of all patient interventions take place in the primary care setting.

General Practices are responsible for providing care to patients between 8.00 am and 6.30 pm Monday to Friday. Outside of these “core hours”, access to medical care is provided by the Health Board’s Out of Hours Service, which operates between 6.30 pm and 8.00 am each week day evening and throughout weekends and Bank Holidays.

All General Practitioners must be on a Welsh Medical Performers’ List to be able to provide General Medical Services in Wales.

2.2 Practice Profiles General Medical services are currently provided by 80 General Practices across the Health Board as set out in the table below.

Table 1: General Medical Services Provision

Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent Number of 11 25 13 18 13 80 Practices Registered Population 72,336 186,479 99,515 152,982 94,709 606,021 (January 2017)

2.3 Sustainability General practice is facing unprecedented and well publicised pressures due to various factors, including GP recruitment and retention difficulties, workload, ageing patient population and increasing complexity of the caseload.

These factors are causing vulnerability which puts practices at risk of closure and significant service reduction.

2.3.1 Sustainability Framework The GP Sustainability Framework was issued by Welsh Government to assist Health Boards to identify practices at risk of having to reduce service provision and/or to give notice to terminate their GMS Contract and offer

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2.3 targeted support. Practices are able to apply for support from the Health Board to stabilise service provision.

A process has been implemented in ABUHB to consider such applications. Since the implementation of the Sustainability Framework, ABUHB has reviewed five applications from practices in accordance with the process. The Primary Care Team and the Primary Care Operational Support Team are actively engaging with these practices to agree and deliver the most suitable support packages. It is anticipated that more applications will be received during 2017/18.

To further support this programme of work, a series of six facilitated Sustainability Workshops for GP practices across Gwent were delivered. The workshop supported a more in-depth conversation with GP Practices to allow the Health Board and Practices to begin the shared design for solutions to the imminent challenges. The format of the afternoon meetings was in two parts.

The first part of the meeting outlined the challenges in broad terms and the solutions that are being implemented elsewhere, eg working at greater scale, altering skill-mix, use of technology. The second session was a facilitated, NCN-level discussion, of the specific challenges in each individual NCN based on current vacancies, projected retirements, population changes and other specific local issues.

The aim was to allow the local professions to explore with the Health Board leadership the solutions that might address local challenges.

In order to have a clear understanding across ABUHB, all GP practices were required to complete and return the sustainability risk matrix. The data from which will now be used to develop a more targeted proactive approach. The Primary Care Operational Support Team will facilitate early discussions and support practices to work more collaboratively where appropriate in order to stabilise the provision of Primary Care Services.

2.3.2 Primary Care Operational Support Team The Primary Care Operational Support Team (PCOST) is a new multidisciplinary team established in 2015/16 with a remit to work with fragile GP practices to support them to become stable and sustainable, funded from the new Welsh Government primary care monies.

Recruitment commenced during summer 2015 with the appointment of GPs and a clinical pharmacist with further recruitment to additional posts following. The team continues to develop and grow and, at this point, the team comprises of:

 1 Clinical Director  4 GPs (2.7 WTE) (2 WTE Vacancies)  1 Senior Nurse/Advanced Nurse Practitioner

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2.3  1 Senior Manager  1 Development Manager  3 Nurse Practitioners  1 Practice Nurse  2 Healthcare Support Workers  1 Clinical Pharmacist  1 Prescribing Support Technician  1 Administrator

Further roles are being considered such as Advanced Paramedics, Physiotherapists, Medical Assistants and Physician Associates.

The Team actively engages with independent contractor practices meeting the sustainability framework criteria, in order to stabilise the practice and work with them to make it viable going forward. The team also provides a short-term urgent support to ensure that a safe level of service delivery can be maintained in exceptional unforeseen circumstances. A service level agreement has been developed and is agreed prior to receiving PCOST support.

During 2016/17 the team supported service delivery at Blaen-y-Cwm Surgery, the Health Board’s directly managed practice. In addition to the managed practice, one independent contractor practice received short-term urgent support due to exceptional circumstances. There have been three independent practices that have received PCOST support following the submission and approval of formal applications under the sustainability framework. The team has also facilitated the practice list mergers.

The reliance on PCOST within the managed practices, along with the number of GP vacancies (six WTE) within the team, has significantly reduced the availability to provide any clinical support to independent practices.

It has been identified that, in order for the managed practices to lead the way in innovation and best practice becoming centres of excellence, testing new models of care and/or to prepare them to be successfully returned to independent status requires clinical leadership, over and above that of a regular salaried GP. It is anticipated that a proposal be developed in 2017/18 for these roles to take the responsibility for driving services forward, in order to have successful managed practices, functioning towards that of on an independent practice.

It is anticipated that further sustainability applications and/or contract resignations will take place in 2017/18. Therefore, PCOST will work with practices to explore new ways of working in Primary Care. This will include having individual practice meetings as well as being involved at an NCN level. This will include consideration to expanding the practice workforce and skill mix, in order to explore alternative models for Primary Care, embracing the Emerging Model for Primary and Community Care. This is a holistic Multi Disciplinary Team model within primary care offering a more proactive and preventative approach to care and is highly likely to reduce 10

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2.3 attendance at emergency departments and avoid admissions.

PCOST itself will be able to test such models, and demonstrate their success through the managed practices.

Looking ahead to 2017/18 the Division will:

2.4 General Practitioner Workforce The Health Board has implemented the All Wales Workforce Plan and a series of actions have been undertaken.

 An action plan has been developed regarding further development of the primary care workforce in Wales and the actions that need to be undertaken by a range of delivery partners to secure, manage and support a sustainable workforce shaped by local population needs and by prudent healthcare principles.

The four main areas where action is needed are:

 Putting in place the foundations for a more robust approach to workforce planning  Supporting the continuing development of primary care clusters and the sharing of best practice  Investing in the development of the wider primary care workforce  Stabilising key sections of the current workforce

A Primary Care Workforce Group has been established. This meets on a monthly basis to review the workforce data, develop recruitment plans and consider alternative roles/models.

A review has been carried out of the staffing complements within primary care for GPs. This provides details of GPs working within practices, as salaried GPs or Partners, to provide a current and accurate database of GP workforce. This will enable the Health Board to identify gaps within practices and provide critical information when there are potential vacancies, i.e. individuals coming up to key points of breaks in services i.e. potential maternity leave and retirement.

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2.3 This will facilitate discussion with individual practices and at an NCN level with succession planning and/or potential sustainability issues.

This is currently being extended to all other disciplines in primary care from Practice Nurses, Health Care Support Workers, Practice Managers and other staff.

The Neighbourhood Care Networks website enables GP practices to advertise vacancies for all disciplines within primary care. This is available to all practices and also includes information on working and living in the area, as well as developments within primary care through the Neighbourhood Care Networks.

In 2016/17, the 12 Neighbourhood Care Networks provided funding to Year Six Students to enrol on a Programme to support them in applying for Medicine as a degree. This has involved a number of support packages which included writing Personal Statements and practical experience of interviews. 43 Students are identified for the programme for 2017/18. This will be extended to a further cohort of students during 2018/19.

This is an innovative piece work which has engaged Sixth Form Leads from the schools/colleges in Gwent, the Seren Network and the Health Board and is ongoing.

A detailed piece of work is currently being carried out around students in Blaenau Gwent to support year 7 through to Year 13 in access and promoting science and support to Medicine as a degree and other health/social care related options.

The Primary Care Team will continue to take a proactive approach to identify needs and addressing gaps within the primary care workforce.

Looking ahead to 2017/18 the Division will:

 Implement actions identified in the All Wales Workforce Plan  Continue to review and report on the workforce data for GP practices to ensure effective succession planning  Continue to report to the Welsh Government and identify further steps that are required to deliver training programmes  Continue to identify and address workforce related issues  Support recruitment and workforce development

2.5 Vacant Practice Local Health Boards have a statutory duty to ensure the sustained delivery of general medical services to their resident population. When a GP practice becomes “vacant”, for whatever reason, the Health Board must ensure that general medical services continue to be provided to those patients by the most effective and efficient means possible having regard to local needs and demographics.

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2.3 The number of GP practices across Aneurin Bevan has reduced from 81 to 80 since last year’s Annual Report.

Aparajita Surgery became a vacant practice due to the retirement of the GP partners with effect from 30 September 2016. This patient list was located in two distinct areas, Brynmawr and Ebbw Vale. The recommendation of the Recruitment and Retention Panel was to split the list, allocating the Brynmawr patients to the Health Board managed practice, Blaen-y-Cwm Practice, and advertise the Ebbw Vale patient list locally. Following the Vacant Practice Process, Pen-y-Cae Surgery, Ebbw Vale, were successful with their business proposal to assume the management of the Ebbw Vale patient list within their substantive GMS contract.

The partners of Tredegar Health Centre advised the Health Board on the 3 March 2017 that they wish to resign their GMS contract with effect from 31 March 2017. Due to the short timescale, the Recruitment and Retention Panel agreed with the recommendation for the practice to become directly managed by the Health Board with effect from 1 April 2017 for a six month period pending the outcome of the Panel’s consideration of the longer term future of the practice.

Ringland Medical Centre became a vacant practice from 30 March 2017 after the partners resigned their contract citing GP recruitment difficulties. The Recruitment and Retention Panel recommended to advertise the practice locally and, following the interview process and submission of their business proposal, Four Elms Medical Centre, Cardiff, were successful in securing the GMS contract for Ringland Medical Practice with effect from 1 April 2017.

2.6 Branch Surgery Closures During 2016/17 the Health Board received three applications to close branch surgery premises. When requests are received to consider branch closures the Health Board does so in conjunction with Aneurin Bevan Community Health Council (CHC) and the Gwent Local Medical Committee (LMC) by means of a Branch Surgery Closure Panel.

These were:  Marshfield, Newport West  Essendene, Blaenau Gwent East  Aberbargoed, Caerphilly North

The Health Board approved the panel’s recommendations to close Marshfield and Essendene and both were closed during 2016/2017.

Aberbargoed will be presented to the Board in 2017/18.

2.7 Boundary Reviews

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2.3 Each GP practice has a specified boundary area for which they provide services, as outlined in the GMS contact, to patients who reside in that area. It is recognised that some practice boundaries are quite sporadic and cover quite large areas that are often far away from the GP surgery. This can cause a variety of problems for both the GP and the Health Board especially when it comes to GP’s undertaking home visits.

During 2016/17, a GP Practice Boundary review exercise was undertaken to ensure that patients can access appropriate medical services within the vicinity in which they live.

During this process a total of 14 boundary changes were received; out of these 14, the review panel supported 11.

The Health Board received an additional four applications from practices at an individual level to review and subsequently reduce their practice boundary:

 Abertillery Group Practice – April 2016 request supported  Nelson Surgery – March 2017 request supported  Llanyravon Surgery – March 2017 request supported  Rugby Surgery – March 2017 request supported

These applications are reviewed by the Primary Care Access Group which includes key stakeholders from the LMC and ABUHB CHC. The panel reviews the application from each practice using the following criteria:

 Practices should ideally retain 70% of their existing area based on registered patient: resident ward  Patient choice will not be adversely affected by the withdrawal of a practice from a particular ward area  Favourable consideration for practices which use ward boundaries and major landmarks e.g. river, motorway to outline the practice areas  Support for single handed practices which many need to radically reduce their practice areas to sustain an ‘open list’ status.  Practice areas should be contiguous

Following the review, the Primary Care Team informs both NHS Wales Shared Services Partnership (NWSSP) and GP practices of the outcome. If the application to reduce the boundary has been supported by the Health Board, practices are advised of the following criteria:

 GP Practices will ensure that no patients are removed unfairly following the change  GP Practices will ensure that patients are fully informed via practice leaflet and website of the boundary change including the implication of future registrations  GP Practices will ensure that all practice staff are informed of the changes in order to implement fairly and consistently

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2.3

It is anticipated that further requests will be received throughout 2017/18 to support practice sustainability.

Looking ahead to 2017/18 the Division will:

 Manage the Vacant Practice process  Continue to support practices who submit applications to change their boundary  Continue to support practices with branch surgery closure requests

2.8 Access to General Medical Services The General Medical Services contract requires General Practices to meet the reasonable needs of their patients throughout core hours of 8.00 am and 6.30 pm, Monday to Friday. This is monitored through the Wales Annual Quality Framework ensuring that Local Health Boards monitor key access indicators to ensure that 100% of General Practices meet contractual requirements for opening times and have telephone access/appointment booking that address patient’s reasonable needs.

In January 2012 the Health Board introduced the “A” is for Access Accreditation Scheme. The scheme provides an indicator of the quality of access offered by each practice and is on display to the public. The scheme is based on a system of an “A” for Achievement of Access, indicating practice performance against five key areas:

 Morning opening time 8.00 am/Consultation start time 8.30 am  Doors to remain open during lunch  Last routine appointment at 5.50 pm  Telephone access to “Live Person” from 8 am to 6.30 pm  “Sort it in one call” (ability to make an appointment, to be seen in one call and/or My Health On-Line (internet booking)

There are two pre-qualifiers for the access accreditation scheme:

 No half day closures  Branch surgeries to complement access with main surgery (if applicable).

Practices that continue to close one half day per week but achieve the indicators listed above are awarded the ‘B’ rating.

There is currently one GP practice that closes for a half day.

The scheme has been widely reported in the media both locally and nationally and has been adopted as good practice. As a result of this initiative the number of practices meeting 5As has increased from 61 in July 2016 to 62 in July 2017 (77.5% of GP Practices).

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2.3 There have been further improvements to the standards of access which includes: As Bs Total Open 8.00am first appointment 8.30am 65 1 66 Open Lunchtime 78 1 79 Summary Last appointment 17.50pm 75 1 76 Telephone Access 8.00am- 18.30pm 79 1 80 Sort in one call 77 1 78 (Reported status April 2017)

Blaenau Gwent Locality

GP "5As" for Access Achievement 12 10 8 No. of GP 6 Practices 4 2 0 2A 3A 4A 5A 2B 3B 4B 5B 1A 1B s s s s s s s s Blaenau Gwent West 0 0 0 0 6 0 0 0 0 6 Blaenau Gwent East 0 0 1 0 4 0 0 1 0 4

Caerphilly Locality

GP "5As" For Access Achievement 18 16 14 12 No. of GP 10 Practices 8 6 4 2 0 1A 2As 3As 4As 5As 1B 2Bs 3Bs 4Bs 5Bs Caerphilly South 0 0 0 0 0 0 0 2 1 4 Caerphilly North 0 0 0 0 0 0 0 0 5 6 Caerphilly East 0 0 0 0 1 0 0 0 0 0 7

Monmouthshire Locality

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2.3 GP "5As" For Access Achievement 10 8

No. of GP 6 Practices 4 2 0 1A 2As 3As 4As 5As 1B 2Bs 3Bs 4Bs 5Bs Monmouthshire South 0 0 0 1 4 0 0 0 0 0 Monmouthshire North 0 0 1 1 5 0 0 0 0 1

Newport Locality

GP "5As" For Access Achievement 18 16 14 12 No. of GP 10 Practices 8 6 4 2 0 1A 2As 3As 4As 5As 1B 2Bs 3Bs 4Bs 5Bs Newport West 0 0 0 0 5 0 0 0 0 0 Newport North 0 0 0 0 6 0 0 0 0 0 Newport East 0 0 0 1 6 0 0 0 0 0

Torfaen Locality

GP "5As" For Access Achievement 10 9 8 7 6 No. of GP 5 Practices 4 3 2 1 0 1A 2As 3As 4As 5As 1B 2Bs 3Bs 4Bs 5Bs Torfaen South 0 0 0 3 4 0 0 0 0 0 0 Torfaen North 0 0 0 1 5 0 0 0 0 0

2.9 Extended Access

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2.3 The Extended Hours Local Enhanced Service (LES) is offered to practices that have attained the 5 “A” is for Access standards.

The Health Board has continued to invest in this LES and there are currently 36 practices commissioned to provide this service.

The number of hours provided by each practice is dependent on list size. The additional hours can be provided by the GP and practice nurse. Primarily the additional session(s) are provided in the evening with some practices providing early morning and evening sessions based on 50:50 basis.

As a result of the LES, an additional 83 clinical hours per week are provided outside of core hours (8:00 am – 6:30 pm). This has improved from 81 hours last year.

No of practices Combined number of Locality Commissioned to provide additional hours provided Extended Hours LES

Blaenau Gwent 2 3

Caerphilly 12 30

Monmouth 7 17

Newport 10 23

Torfaen 5 10

Aneurin Bevan UHB registered population (as of 1 April 2017) is 606,614. This equates to 55% of registered patients being covered by the Extended Hours LES.

2.10 Optimising Access in General Practice Optimising Access formed one of the core elements within the January 2015 Board report where it was agreed that a programme of work would be initiated, in conjunction with the Local Medical Committee and Community Health Council to:

 Define reasonable expectations of access in conjunction with the Local Medical Committee and Community Health Council.  Understand the current demand and supply for services.  Working with Neighbourhood Care Networks and practices to develop “Access improvement plans” to close the gap between demand and supply.

2.10.1 Reasonable Access Expectations Whilst the Health Board has developed a number of schemes to improve access to GP services, historically we have used opening times and the number of GPs as a proxy for primary care supply which has limitations as

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2.3 this measures the frame of the day as opposed to the productivity during the day.

In the absence of a clear contractual definition of expectations in relation to access, the “principles of access” outlined below have been developed in conjunction with the Local Medical Committee and Community Health Council. This acts as guidance on reasonable access expectations and would be subject to clinical judgment and constrained by service capacity and other pressures on practices.

All patients presenting with true medical emergencies e.g. severe chest pain, severe shortness of breath, loss of consciousness would be managed in accordance with clinical urgency and local guidance. This might include immediate sign-posting to emergency hospital services, ambulance services or rapid practice-based or domiciliary consultation.

For non – emergency presentations:

 Urgent – Offer of a consultation same day – acute presentations that can’t wait for up to 48 hours. This would be dependent on clinical need and clinical judgment. The consultation could be face to face, telephone or home visit.  Soon – Offer of a consultation, within 48 hours, of request - for acute presentations not necessitating same day consultation  Planned – Offer of a consultation within two weeks of request (unless patient chooses to defer further).

As part of the discussions, the group determined that, ordinarily, all children under 16 years of age with acute presentations should be offered a same day consultation. Any variations to the timeframe are to be based on clinical judgment and mutual agreement between the GP and parent/guardian.

All of the above would be based on clinical judgment. The ability to provide a consultation within a clinical session would be determined based on clinical need i.e. patient request same day appointment – clinician would determine whether this requires urgent care and therefore patient seen in that session or whether it would be appropriate for the patient to be seen in the next session (following day).

2.11 Access Quality Improvement Scheme This scheme was developed to identify and understand the existing demand and supply for GMS services and to work with practices to develop access improvement plans to optimise access. The scheme is funded via Welsh Government Primary Care Pacesetter funding.

The Health Board launched the new Access Quality Improvement Scheme in January 2016, which was developed and agreed with the Local Medical Committee and Community Health Council, to build on the achievements already made by practices to improve access.

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2.3

The scheme was split into two phases:

 Phase 1 – Identifying capacity and supply and developing Improvement plans Practices are required to undertake a full and comprehensive review of their accessibility (access) for their patients and, using the data obtained from the review, develop a robust access improvement plan which identifies issues identified from the review and taking into account relevant NCN priorities. This also includes a patient and staff survey.

 Phase 2 – Delivering Improvement Those practices that have completed phase 1 were invited to participate in Phase 2.

This element involved specific interventions to optimise access to GP practices, for example, new telephone and booking systems, embracing new approaches such as telephone triage and software facilitated consultations.

During 2016/17 those practices who did not participate in Cohort 1 which started in 2015/2016 were invited to apply to participate as part of Cohort 2.

An additional seven practices participated fully in both Phase 1 and Phase 2 during 2016/2017 taking the total to 47.

During 2017/18 practices will be contacted to assess the results of their implementation plans and the impacts the specific interventions identified and provided as part of the initiative have had on their practices.

A further six practices worked with an external provider, Operasee, to assess the impact on practice work/patient experience using LEAN methodologies. The provider worked intensely with practices to assess their demand and capacity constructing a Patient Routing Analysis which was used to assess the rate at which patients are presenting to the practice and their specific need at that time. That information was then used to determine the required staffing levels to meet patient demand and further interrogated to identify the most appropriate health professional to deal with the patient’s need. The study also identified the time taken to handle calls coming in to the practice and the optimum administration staffing levels required at different times to deal with these appropriately.

Results of this assessment were delivered to the Health Board at the end of the year and the Primary Care team is awaiting the final report.

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2.3 Dependent on the outcome, this will support and inform the delivery programme for 2017-2018.

2.12 My Health Online (MHOL) The difficulty in getting through to GP practices in order to make an appointment is something that patients regularly quote in patient surveys and communication.

One of the ways to improve access for patients is to enable them to book appointments directly via the use of “My Health On Line” which is a web based appointment system that allows patients to book appointments and order repeat prescriptions with their GP Practice 24 hours a day.

The graphs below demonstrate the usage of My Health Online within ABUHB as at June 2017.

% of practices using elements of MHOL

100

50 99 97 92 89 100 91 84 71 % of practices using 0 elements of MHOL

120

100

80 % of practices 60 using prescriptions 40 % practices using appts 20

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2.3 The Health Board is committed to continuing to promote the use of My Health On Line and increase the number of GP practices offering this facility for appointments and prescriptions.

2.13 Incentives During 2016/17 the Division received funding from a review of GMS premises rateable values which was undertaken on the Health Board’s behalf by an outside contract, GVA Grimley.

Directions from Welsh Government confirmed that the Health Board could use this one off income to fund projects to strengthen GMS services in primary care ensuring no recurring funding implications occurred.

As result, during 2016/17 the division funded the following one-off initiatives for GP Practices:

 CPD Sessions for Nurses and GPs  Support for the Store and Scan initiative  Telephone voice recording equipment  Portable Hearing Loops  Clinical training sessions  Additional Medical Equipment

Looking ahead to 2017/18 the Division will:

 Continue to work with practices to ensure the optimum standards of access to General Medical Services are available to patients throughout the core hours of 8.00 am - 6.30 pm.  Review the extended hours LES  Embed the Reasonable Access principles  Continue to improve General Practitioner Access standards across the Health Board and encourage the uptake of My Health On Line for both appointments and repeat prescriptions.  Progress the Optimising Access in General Practice work programme  Evaluate the findings and recommendations of the Operasee report and determine the next steps for the Access QI work programme

2.14 Quality and Outcomes Framework The Quality and Outcomes Framework (QOF) provides information in relation to a wide range of clinical indicators, providing one method for measuring and evaluating the consistency of clinical care delivery.

The Framework promotes the use of evidence-based medicine but allows flexibility for clinical judgment and patient choice through exception reporting.

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2.3 Figure 1: ABUHB Average Disease Prevalence 2016-17

QOF Disease Prevalence 2016/17 120

100

40 LHB Average National Average 20

EP%

AF % AF

BP BP %

PC PC %

HF%

LD%

RA % RA

OB%

MH%

DM DM %

FLU %

HYP%

AST %

DEP%

OST%

CAN %

CHD%

DEM%

STIA %

COPD % CVD-PP%

SMOK02&05 % The average number of Quality and Outcome Framework points achieved for 2016/17 across Aneurin Bevan University Health Board differed in each borough, from an average of 547 out of a total of 567 in Blaenau Gwent to 563 out of a total of 567 in Monmouthshire, as demonstrated in the chart below:

Figure 2: QOF Average Points Achieved by Borough 2016-17

Average points Per Cluster 565 563 559 560 558 556 555 550 547 545 Average points Per 540 Cluster 535

The new General Medical Services contract sets measurable standards for Primary Care services. The Quality and Outcomes Framework was

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2.3 introduced as an integral part of the new General Medical Services Contract in April 2004. Practice performance is measured and paid for through a points system, the Quality and Outcomes Framework. This framework was designed to raise organisational and clinical standards in Primary Care. Participation in Quality and Outcomes Framework is voluntary to enable practices to choose which elements of the quality framework they want to undertake.

The Quality and Outcomes Framework is divided into four “domains”. These are:

 Clinical  Public Health  Medicines Management  GP Cluster Network Development (CND)

The following table outlines the breakdown of points available:

Atrial Fibrillation 26 CHD 2 Heart Failure 7 Hypertension 27 Stroke/TIA 2 Diabetes 52 Asthma 28 COPD 26 Dementia 30 Depression 10 Mental Health 27 Cancer 8 Epilepsy 3 Learning Disability 2 Osteoporosis 2 Rheumatoid Arthritis 11 Palliative Care 9 Clinical Total = 272 CVD – Primary 10 Blood Pressure 10 Obesity 2 Prevention Smoking 62 Cervical 13 Influenza 20 Screening Public Health/Additional Services = 117 Meds Man = 18 CND = 160

Within each domain there are a number of indicators which relate to quality standards or guidelines that can be achieved within that domain. There are 567 points in total available for the four domains which are worth approximately £163.98 for a practice with an average weighted population of 6,962 patients.

The role of the Health Board is to support, monitor and approve the annual achievement reported by each practice. To monitor achievement practices are required to submit information on an annual basis to demonstrate performance in respect of the indicators.

Due to the QOF relaxation in 2016/17, only three practices were identified as requiring a visit. These were undertaken by the Clinical Director for PCOST. The end of year achievements were reviewed by the Quality and Outcomes Framework Review Panel comprising of the Deputy Medical Director, Primary Care Managers and representation from Finance. In order to assist the Review Panel in determining Quality and Outcomes Framework 24

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2.3 visits, Contract Manager Web data was collated to identify discrepancies in practices’ prevalence or exception reporting rates (+/- two standard deviations). A full QOF report is provided each year.

2.15 Enhanced Services Enhanced Services are commissioned in addition to essential services or deliver higher than specified standards, with the aim of increasing the delivery of care in the community setting and reducing demand on secondary care. Enhanced services expand the range of services to meet local need, improve convenience and extend choice.

Primary Care Anticoagulation Service: The All Wales negotiations between the General Practitioners Committee (GPC) Wales and Welsh Government to develop a Directed Enhanced Service (DES) have been delayed with a view to a new DES being issued to NHS Wales in 2017/18.

Consequently an agreement has been reached with the Gwent Local Medical Committee to develop an interim Local Enhanced Service (LES) which will be replaced with the All Wales DES when available.

The interim LES was finalised and issued to practices in January 2017. The service specification enables practices to provide the full point of care and dosing service (currently Level 4).

The Extended Skin Surgery Local Enhanced Service: The purpose of the Extended Minor Surgery LES is to enable GPs with the required skills to undertake specific procedures within a primary care setting. This LES commissions Extended Minor Surgery Services from a cohort of GPs appropriately accredited to treat patients referred to them by ABUHB’s Dermatology Department and thus includes patients who are not registered with their General Practice. There are currently five practices (six accredited GPs) commissioned to provide this service which was funded via the new primary care monies received from Welsh Government.

2016/17 results are shown below:

SUMMARY OF ACTIVITY April 2016 - March 2017 Waiting No of No List Referrals Treated DNA Size Qtr 1 114 86 0 26 Qtr 2 120 96 0 24 Qtr 3 43 27 0 2 Qtr 4 118 80 5 29 Total 395 289 5 81 25

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2.3 Primary Care Nurse Led Childhood Immunisation Team The GMS contract specifies that practices are responsible for delivering the childhood immunisation programme unless they opt out of doing so. This is supported financially via the Additional Service Payments, included in the Global Sum and the payments made under the Enhanced Service for achieving childhood immunisation targets. In Gwent, 40% of practices have directly delivered the immunisation programme using practice employed staff, whereas in others the immunisations have been administered by Health Visitors. All practices receive payments on the same basis whether they directly administer the immunisations or not.

The Health Board determined that in order to maximise vaccine uptake, and ensure all practices were treated equitably, that all practices should be required to take responsibility for delivering this service.

It was acknowledged locally that this may be financially challenging for many of the 60% of practices that currently do not deliver this service in- house, and that they may require additional staff in place to deliver this service, also recognising the increasingly complex Childhood Immunisation programme that some practices currently deliver, some of the new monies from the Welsh Government were dedicated to support this service.

ABUHB, in consultation with the Local Medical Committee, modelled an alternative delivery option giving practices a choice in which to deliver the service themselves or procure the service from the Health Board.

Practices were given the following options:

 procure the Health Board Immunisation Team  provide the service in house for the first time  maintain the current provision

A robust training programme was developed by the Childhood Immunisation Coordinator and roll out was supported by the Families and Therapies Division.

17 practices expressed an interest in procuring the services of the ABUHB Immunisation Team. These Practices were issued with individual financial statements for consideration. Of these, seven practices opted to provide an “in- house” service and 10 practices confirmed that they wished to procure the service from the Health Board.

The service became fully operational in October 2016.

Directed Enhanced Services

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2.3

Childhood Immunisations: The purpose of this enhanced service is to continue to ensure that a high percentage of children aged five years and under receive the appropriate immunisations in a timely manner:

 immunising children aged two years and under; and  pre-school boosters for children aged five years and under.

Asylum Seekers and Refugees: This service is to address the specific healthcare needs of asylum seekers and refugees. It seeks to provide equitable access to general medical services by overcoming barriers such as language and allowing extended consultation time to address complex issues.

Learning Disabilities: This service is for the provision of general medical services for adults with severe learning disabilities. The scheme aims to improve the quality of care provided through general medical services to patients with learning disabilities.

Homeless: The service is to address the specific healthcare needs of local homeless people. It seeks to provide homeless and vulnerable people with access to general medical services and referral to other services.

Minor Surgery Addendum: An activity cap based on 50p per registered patient, per annum, was introduced in 2012. Practices were issued with an indicative quarterly cap with an agreed upper threshold of 10% over performance in each quarter. Practices are able to apply for additional activity where they have reached their quarterly cap. This is reviewed annually and will next be reviewed in 2017.

Mental Illness: The aim of the Directed Enhanced Service is to engage the whole practice team including clinical, managerial and administrative staff to develop a clear and shared understanding of the experience of patients with mental health issues, the links to physical health, the needs of young people and the elderly and the management of self harm and threatened suicide. Informed teams can ensure that services respond effectively to patients needs, with patient experience a key priority.

Violent Patients: Violent patients present a more serious risk and the role of the Health Board is to ensure that alternative service options are in place to minimise any risk to GPs and their staff. For the purposes of Immediate Removal, patients will be designated as violent by the Health Board if an incident has occurred requiring police involvement and necessitating immediate removal from a practice’s list. The above definition covers violence enacted by patients, their relatives or carers, or indeed anyone posing a threat to GPs, their staff or other patients. The purpose of this enhanced service is to define processes for the management of Violence and Aggression within General Practices.

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2.3 The provider practice and Gwent Police SLAs were reviewed, updated and uplifted in 2016/17.

Pneumococcal Vaccine (PPV): The JCVI (Joint Committee for Vaccinations and Immunisations) have concluded that, whilst uncertainty remains about the effectiveness of PPV, there is better evidence from the UK experience of the vaccine suggesting that PPV provides some moderate short-term protection to those aged 65 years and older. JCVI has advised that the existing routine universal PPV programme for those aged 65 years and older should continue but be kept under review.

Influenza: The purpose of the DES is to ensure the provision of influenza immunisation for those aged 65 and over and other at-risk groups. This is to reduce the serious morbidity and mortality from influenza by immunising those most likely to have a serious or complicated illness should they develop influenza.

This can avert the need for the patient to be hospitalised. Practices who provide the enhanced service will agree to be fully compliant with the professional advice that is published by the Chief Medical Officer from time to time in respect of the delivery of the immunisation programme.

National Enhanced Services

INR: The anti-coagulation monitoring enhanced service is designed to be one in which:

 therapy should normally be initiated in secondary care, for recognised indications for specified lengths of time  maintenance of patients should be properly controlled  the service to the patient is convenient  the need for continuation of therapy is reviewed regularly; the therapy is discontinued when appropriate.

The National review that was ongoing during 2016/17 concluded at the end of the year and culminated with the introduction of a new DES which will be rolled out to practices in 2017/18.

Significant work has been undertaken in respect of this enhanced service to shift services from Secondary Care in to Primary Care during 2016/17.

A total of 69 practices indicated that they wished to provide services to their patients from their practice premises.

Two training sessions were held with practices receiving bespoke training from 4S DAWN, the software provider.

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2.3 All interested practices have been supplied by the Health Board with at least two Point of Care testing machines to enable them to operate this service within their practice.

During 2016/17, 14 practices provided patients with this service. The remaining practices will “go-live” during 2017/18 on a phased basis.

Substance Misuse: The aim of this service is to provide a joint comprehensive service for substance misusers within nominated practices within Aneurin Bevan University Health Board.

Shingles: The aim of this Local Enhanced Service is to ensure that the shingles vaccine is offered to all eligible patients, on an opportunistic basis, who are 79 years old, but not yet 80 on 1 September each year.

Men ACWY Conjugate: This programme was implemented in 2015/16 to respond to an outbreak situation which saw a sudden, rapid and accelerating increase in cases of meningococcal group W (MenW). It was aimed for the introduction of MenACWY immunisation to have a significant effect on reducing carriage and is to continue for the foreseeable future.

Men B: The introduction of the MenB immunisation aimed to have a significant impact on reducing cases of meningitis and septicaemia and their complications in infants, and provide reassurance to parents who are concerned about the devastating consequences of the disease.

Local Enhanced Services

Diabetes Local Enhanced Service: This new Local Enhanced Service provides an incentive to practices to maintain the management of diabetic patients exclusively in Primary Care and support the introduction of using the “Year of Care” or Royal College of General Practitioners Care Planning approach. The enhanced service is currently undergoing a National review which is expected to conclude during 2017/18.

Care Homes Local Enhanced Service: This Local Enhanced Service allows General Practitioners to take a proactive approach to caring for registered patients currently living in care homes. The service remunerates practices for implementing a programme of assessment and regular review of the mental and physical health of their care home population to include, where appropriate, end of life care planning.

The National review that was ongoing during 2016/17 concluded at the end of the year and culminated with the introduction of a new DES which will be rolled out to practices in 2017/18.

The aim of the DES, which builds on the benefits of the previous enhanced service provision, is to enhance the care provided for residents in care homes through a proactive, holistic coordinated model of care. There is a

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2.3 strong emphasis on prudent healthcare principles where the clinical skills and abilities of all members of the primary care team are maximised. In particular, the DES will seek to (a) deliver best-evidenced treatment and services to the most appropriate level based on individual need; maximise the continuity of care; (b) minimise unplanned transitions of care; (c) minimise the risk of poly pharmacy and (d) ensure the most appropriate professional is available to deliver care.

Extended Opening Hours Local Enhanced Service: A specification enabling practices to provide a more flexible range of appointments. Practices must have met the 5A requirements in order to meet the eligibility criteria.

Gonadorelins Local Enhanced Service: A specification for the administration of gonadorelins for patients with carcinoma of the prostate, carcinoma of the breast, pre-operatively for women having hysterectomies and those with endometriosis.

Intra Uterine Contraceptive Devices/Intra Uterine Devices for Registered Patients: The aims of this service are to:

 ensure that the full range of contraceptive options are provided by practices to patients;  ensure that the availability of post-coital IUCD fitting for emergency contraception should be more adequately provided as another means of reducing unwanted pregnancies;  increase the availability of LNG-IUS in the management of menorrhagia within primary care.

Intra Uterine Contraceptive Device for patients not registered with a Service Provider Local Enhanced Service: This Local Enhanced Service enables practices to provide Intra Uterine Contraceptive Devices/Intra Uterine Devices on behalf of practices that do not provide this as a National Enhanced Service.

Near Patient Testing Local Enhanced Service: The previous five levels have now been replaced by one payment of £80 per patient per year. Specification states “Practice funded phlebotomist, practice sample, laboratory test, practice monitor and prescribe accordingly, dose adjustment by or guided by secondary care”.

Contraceptive Injection (Depo-provera): This service is to provide Parenteral Contraceptive Injections thereby improving the range of contraceptive services provided by GP practices to patients.

Contraceptive Implants (Nexplanon): This service was introduced following the decommissioning of the Implanon enhanced service. GPs are required to undertake a specific training programme in order to be

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2.3 accredited for this new service to provide Parenteral contraceptive subdermal devices.

Human Papilloma Virus: This service was introduced to support the Ministerial Letter of 29 November 2011 to provide Human Papilloma Virus vaccination for girls within the routine programme from 12 to 17 years of age but not able to be vaccinated in school as part of the routine schools programme. This guidance was changed in order to change from a three dose to a two dose schedule. This is a routine preventative programme the primary aim of which is to reduce individuals’ risk of cervical cancer due to infection with Human Papilloma Virus types 16 and 18.

Measles, Mumps and Rubella – Catch Up: The purpose of this document is to set out a Local Enhanced Service to ensure the follow up and offer of Measles, Mumps and Rubella to those individuals who may not have received two doses of Measles, Mumps and Rubella. This is to reflect the public health emergency as a result of the Measles outbreak in Swansea.

Measles, Mumps and Rubella - Post Natal: This service is to provide post natal women, who are rubella susceptible, a 2nd Measles, Mumps and Rubella vaccine.

Lithium: This service was introduced to support the prescribing of lithium within General Practices where the patients have been stabilised by secondary care.

Dispensing Quality Scheme: This quality payment is only available to dispensing practices.

Denosumab Local Enhanced Service: This enhanced service is for the treatment of patients at risk of osteoporotic fracture. Osteoporosis is a condition characterised by reduced bone mass density and deterioration of bone tissue which results in increased bone fragility and susceptibility to fracture in simple falls.

During 2016/17, this enhanced service was amended to include the treatment of men. Denosumab (Prolia®) can be made available within NHS Wales for the treatment of osteoporosis in men at increased risk of fractures. Denosumab (Prolia®) should only be made available for men who fulfil the agreed criteria for treatment

Pertussis: The aim of this LES is to prevent cases and deaths due to pertussis in infants in the period before they can receive routine childhood vaccination by ensuring that pertussis vaccination (Repevax®, dTaP/IPV vaccine) is offered to all eligible pregnant women. Since the LES was implemented, new research has emerged showing that maternal immunisation earlier in pregnancy (i.e. the 2nd trimester) is safe and increases antibody transfer to the infant. The earlier timing will also help to ensure protection for babies who may be delivered prematurely. This is

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2.3 particularly important as premature infants are over represented in cases of whooping cough occurring at this time.

The most effective protection of the infant will be achieved though vaccination during pregnancy and this therefore is the priority.

Rotavirus: Rotavirus is a very common and potentially serious intestinal infection of young babies. The rotavirus vaccine was included in the childhood immunisation programme from 1 July 2013.

Syrian Vulnerable Person Resettlement Scheme (SVPRS) The Primary Care and Networks Division are actively engaged in the resettlement process. The Deputy Medical Director, Primary Care, assesses Home Office referrals to ensure the needs of Refugee families can be met within ABUHB. The Primary Care Team facilitates the registration of families to local GP practices, liaising with partners including Local Authority and Shared Services Partnership.

GP practices registering Syrian families are entitled to claim against the existing Direct Enhanced Service for Asylum Seekers and Refugees for Year 1. This aims to provide equitable access to general medical services by overcoming barriers such as language and allowing extended consultation time to address complex issues. The Enhanced Service also requires that practice staff demonstrate understanding and sensitivity towards asylum seekers and refugees particularly with regard to culture and language. It also aims to ensure effective liaison between the practice and the specialist nurse so that asylum seekers and refugees are aware of how to contact the practice. Families are able to access main stream dental and optometry services independently of the Health Board.

In 2016/17, Local Authorities in Gwent have indicated that they will identify sufficient properties to accept around 100 families over the next five years. This represents around 400-600 Syrian refugees in the ABUHB area housed in approximately 110 houses.

During 2016/17 the Health Board supported the registration of 15 refugee families.

Looking ahead to 2017-18 the Division will:

 Continue to monitor QOF  Continue to work with practices to implement the new anticoagulation service model following the introduction of the new DES  Monitor the Extended Skin Service  Review the minor surgery cap activity  Maximise uptake in childhood immunisation  Improve uptake of Mental Health and Learning Disabilities DES  Finalise the review of the Alternative Treatment Centre policy

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2.3  Implement the revised enhanced services in accordance with revised national guidance Care Homes and Diabetes  Review the enhanced services activity and liaise with practices to promote and improve uptake  Continue to support the delivery of services to Syrian Refugees  Review and facilitate inter practice referrals for those enhanced services that are not provided by all practices  Review the Childhood Immunisations Service Level Agreement

2.16 Contractual Governance and Assurance

2.16.1 Annual Review Process In accordance with The National Health Service (General Medical Services Contract) (Wales) Regulations 2004, all Health Boards are required to review information on an annual basis from its General Medical Services Contractors.

General Practices are required to provide assurance that the statutory and contractual obligations are being adhered to. This is measured via the Clinical Governance Practice Self Assessment Toolkit (CGPSAT) and any additional policies/procedures. This information is reviewed internally and used to conduct an Annual Review visit with the practice. These meetings provide a useful opportunity for discussion of the practices performance against contractual and governance parameters and for the discussion of priorities for improvement and areas for further development e.g. Access, provision of Enhanced Services, Premises Improvements. Whilst all practices have a minimum of one meeting with Health Board staff per annum, many are offered more intensive support dependent on individual practice circumstances and need.

The focus of the Annual Contract Review visits this year was on the Clinical Governance Practice Self Assessment Toolkit (CGPSAT) and linking it in with the contractual statutory requirements. This year the matrices that were included in the visits were:

 Business/Partnership Risk  Infection Control  Safeguarding Children  Safeguarding Vulnerable Adults  Access to Consultations

A new time period for conducting the visits has been implemented and now operates from June to December. This allows the Primary Care Team to review current data and information from practice submissions of the CGPSAT in March 2016/17.

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2.3 Looking ahead to 2017/18 the Division will:

 Continue to ensure all General Practices receive an annual contract review.  Continue to ensure Primary Care Nursing Team and Quality and Patient Safety Team input into the annual review process and visits.  Continue to support the use of the Clinical Governance Practice Self Assessment Toolkit.  Engage in NCN collaborative working

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2.3 3 Access to General Dental Services

3.1 Strategic Context General Dental Practitioners are independent contractors who deliver National Health Services via a nationally negotiated contract (The General Dental Services (GDS) contract or Personal Dental Services (PDS) Agreement 2006).

The Health Board holds contracts for the provision of General Dental Services and Orthodontics and activity is commissioned as Units of Dental Activity (UDAs) and Units of Orthodontic Activity (UOAs). In addition to this activity the Health Board commissions activity to provide Domiciliary Care, Emergency Dental Services, Minor Oral surgery services, Sedation services and services for Her Majesty’s Prisons in Usk and Prescoed.

3.2 Practice Profile There are approximately 290 General Dental Practitioners (GDPs) delivering dental services through 112 General, 10 Orthodontic and one mixed Dental Service contracts across Aneurin Bevan University Health Board. In 2016/17 the Health Board commissioned 1,022,002 Units of Dental Activity and 30,275 Units of Orthodontic Activity while treating 300,315 general and 3,184 orthodontic patients respectively.

Table 2

Number of GDS/PDS Contracts Borough General Orthodontic Mixed

Blaenau Gwent 12 1 0

Caerphilly 36 3 0

Monmouthshire 18 2 0

Newport 28 4 0

Torfaen 18 0 1

ABUHB Total 112 10 1

3.3 Governance Arrangements in General Dental Services A number of groups have been set up across the Health Board to provide assurance around the governance and management of Dental Services and provide clinical advice.

The groups and their roles are set out below:

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2.3 Integrated Oral Health Strategy Group This group is chaired by the Associate Director of Integration and Innovation and has clinical and management representation from Primary Care, Hospital Care, Community Dental Services and Public Health Wales.

The Group acts as a forum to oversee and recommend Clinical Governance arrangements across the Dental Pathway and provide Clinical advice/recommendation to the Primary Care and Community Board and Executive Team.

The Integrated Oral Health Strategy Group requested that a referral pack was developed to support GDPs when making referrals in to dental services. This pack was compiled by the Primary Care Team and issued to all clinical professionals in March 2016.

The group continues to support the continued development of the Local Oral Health Action Plan.

Dental Quality and Patient Safety Group This group is chaired by the Clinical Director for Community Dental Services with clinical and management representation from Primary Care and Public Health Wales.

The group provides assurance on Quality and Patient Safety and reports to the Primary and Community Care Division’s Quality and Patient Safety Group.

Quality and Patient Safety Continued Professional Development (QPS CPD) The Health Board facilitated a CPD evening where General Dental Practitioners and appropriate staff were invited to attend in September 2016. The Health Board is currently in the process of arranging a further event in September 2017.

3.4 Annual and Quarterly Review Process All dental contract holders are contractually obliged to transmit their activity data on a monthly basis to NHS Dental Services and it is through these claims that the Health Board can monitor performance.

The Health Board has developed a process for the management of exception reports and vital signs information, generated by the National Health Service Dental Services Division for the Health Board on a quarterly basis. This information is used to consider whether there are clinical or service issues which may be explained by practices being highlighted as an outlier, or if there are risks that need to be managed.

The Primary Care Directorate reviews these reports over five quarters to identify any trends through a risk management approach; in particular this information is used to undertake annual reviews with Dental Contractors

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2.3 enabling them to make responses to any concerns that may be raised following a review of the data on an annual basis.

The Health Board has two employed Dental Advisors who provide a service to both dental contractors and the Health Board and ensure appropriate contractual and clinical advice is provided to both parties. The Dental Practice Advisors have a remit to carry out practice inspections on behalf of the Health Board and during 2016/17, 34 annual review visits were successfully completed, which were either clinically or managerial led. The series of visits during 2016/17 commenced the second cycle of the three- year cycle.

Since August 2014 Health Inspectorate Wales (HIW) have undertaken practice inspection visits over a three-year rolling programme. During 2016/17 HIW undertook 18 practice inspection visits across ABUHB. The inspection reports are published on the HIW website for the public to view along with the agreed Improvement Plans.

On an annual basis, dental contractors are also expected to complete the Quality Self Assessment Questionnaire online provided by Public Health Wales. This online questionnaire asks a variety of questions ranging from details of the premises to policies that should be in operation at the practice. This information is returned to the Dental Practice Advisors for assessment and a report is provided to the Health Board detailing any actions the practices need to implement and specific time frames. In total, 80 Quality Assessment Questionnaire returns were made across the Health Board of which, 13 required no follow up action. The table below summarises the follow up action required to report back to the National Public Health Service Dental Advisor.

Table 3

Follow Up No Action Borough No of Practices Action Required Required

Blaenau Gwent 10 2 8

Caerphilly 22 4 18

Monmouthshire 16 2 14

Newport 19 2 17

Torfaen 13 3 10

Total 80 13 67

The Health Board has arrangements in place to investigate concerns about clinical performance and to support individual practitioners through this 37

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2.3 process. The Division has adopted the All Wales procedure for managing concerns about performance by General Dental Practitioners and the Dental Quality and Patient Safety Group oversees any issues and concerns raised.

Looking ahead to 2017/18 the Division will:

 Continue to engage with the new Integrated Oral Health Strategic Group.  Facilitate the Dental QPS CPD Programme.  Continue to comply with the Public Health Wales ‘Model Dental Governance Framework for General Dental Services’ and ‘Delivering NHS Dental Services more Effectively’ to ensure a robust process is in place for quarterly and annual monitoring.  Support the Primary Care Quality and Patient Safety team with regards to the HIW monitoring process.  Maintain the monitoring of Quality Assurance System uptake across all Dental practices.  Continue the Annual Review Visits to Dental Practices (3rd cycle)

3.5 General/Personal Dental Services During 2016/17 there continued to be access concerns across Aneurin Bevan University Health Board.

Clinical guidelines issued by the National Institute for Health and Clinical Excellence stipulate that adults should see a dentist at intervals between 3 and 24 months, dependent on clinical risk. The report of the review of National Health Service Primary Care Dental Provision in Wales Cardiff University and Public Health Wales (June 2011) highlighted that access to general dental services across Wales was not helped due to the numbers of individuals who were being reviewed before this evidence-based guidance suggested that they needed to be seen.

The most common re-attendance intervals within the Health Board is between 3 to 9 months which suggests that a large number of patients and their dentists maintain a six-monthly to nine-monthly recall, but for others a longer recall period may be more appropriate. There is however no robust data available to determine what proportion of dental patients should attend at given intervals and Aneurin Bevan University Health Board is continuing to work with individual providers to address this.

Data over a 12-month period to March 2017 illustrates an increase of 994 patients accessing General Dental Services in Gwent.

The Health Board has continually monitored Dental Practices to identify the current capacity to accept new National Health Service patients. The information given by practices up to March 2017 highlights the relatively low numbers of General Dental Practitioners able to accept new National Health Service patients within Gwent. However, it should be noted that the

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2.3 numbers of Practices accepting all patients has increased significantly since 2015/2016.

Table 4

No of Dentists accepting new patients Borough Children Only Exempt Only All Patients

Blaenau Gwent 0 1 2

Caerphilly 2 1 4

Monmouthshire 0 1 6

Newport 0 0 7

Torfaen 0 0 3

The Health Board continues to recognise the issues relating to access for patients to NHS dental care.

Looking ahead to 2017/18 the Division will:

 The Division recognises the access issues and has invested an additional £75,000.00 to increase dental access. Therefore, six Personal Dental Service contracts have been established totalling £250,000.00 additional spend.  The Division has received a further £300,000.00 in 2017/18 from Welsh Government to address the access issues. The Primary Care Team is currently reviewing the access issues in order to target the areas in highest need/demand for dental services.  The Division will engage with Welsh Government and Dental Public Health Wales and support practices during the contract reform process.

3.6 Orthodontic Dental Services Orthodontic access across the Health Board ranges between three to 36 months from referral to assessment and two to 42 months from assessment

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2.3 to treatment. All General Dental Contractors must consider the age of a patient at the time of referral and make a clinical judgment to refer patients to the most appropriate provider. Figure 4 provides an overview of the Orthodontic courses of treatment provided during 2016/17 with 23.2% of patients assessed and reviewed, 42.5% of patients assessed and treatment commenced and 22.2% completing their course of treatment in 2016/17.

Figure 4

Breakdown of Orthodontic Activity 2016/17 1.6% 0.0% 4.1% 0.6% Assess and Accept / Start Treatment Assess and Review 22.2% 42.5% Assess and Refuse

5.6% Treatment Completed

23.2% Treatment Abandoned

Treatment Discontinued

In 2016/17 the Division invested an additional £84,000.00 which allowed for 60 new patients to be assessed and treatment started.

In November 2015, Welsh Government issued updated guidance on the ‘Delivery of Orthodontics in Primary Care’, which the Health Board has adopted. Within this guidance, new indicators have been identified which the Health Board will review against each Orthodontic contract and the review will be ratified with the Orthodontic Managed Clinical Network Group.

Looking ahead to 2017/18 the Division will:

 Continue to monitor Orthodontic Contracts in line with recommendations made by the Managed Clinical Network Group for Orthodontics.

3.7 Domiciliary Dental Care Domiciliary services are provided to housebound patients who are unable to access dental services in a primary care setting.

The Division awarded two Personal Dental Service contracts to local General Dental Practitioners in 2014 for the residents of Blaenau Gwent, Caerphilly, Newport and Torfaen to be able to access domiciliary care. It should be noted that the domiciliary service provided in Monmouth remains.

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2.3 Following a review, the Division agreed that it would be more beneficial for patients to be able to access care closer to home and within the borough that they reside. Therefore, both contracts terminated on 31st March 2017. The Health Board purchased four domiciliary kits on behalf of the successful providers to help assist practices with ‘start up costs’. The Division is currently tendering for this service. In the meantime, the Community Dental Service are currently providing services to emergency patients while maintaining a waiting list for the non emergency referrals. The service continues to be facilitated by the Dental Helpline.

The service will continue to ensure equity in access to high quality, timely domiciliary dental services for all Gwent residents.

Looking ahead to 2017/18 the Division will:

 Continue to monitor the new domiciliary service ensuring access is sufficient for vulnerable people across the Health Board  Re-tender the service in 2017/18

3.8 Commissioning of Occupational Health Service Since 2012-13 the Division has commissioned a full Occupational Health service from the Aneurin Bevan University Health Board Occupational Health Department for all General Dental providers and their staff and extended this service for 2017/18. Uptake for this service is continuing to increase.

3.9 Minor Oral Surgery Service Historically Gwent residents have faced significant waiting times to access minor oral surgery services within ABUHB hospitals as a result of highly specialist maxillofacial clinicians having significant workloads for more complex care as well as minor oral surgery.

Prior to April 2014, if a patient’s treatment was too complex to be undertaken within the competency of a General Dental Practice in a Primary Care setting, the patient’s dental practitioner would refer the patient in to the Hospital setting.

Since its inception, the Division has been working with the Hospital Dental Service, Community Health Council, Dental Public Health, Community Dental Services and the Local Dental Committee to review current arrangements and create an acceptable clinical pathway which would ensure equitable access to dental services for patients who required Minor Oral Surgery services in a Primary Care setting across Aneurin Bevan University Health Board.

The Primary Care Division, in partnership with the Scheduled Care Division, reviewed the patient waiting list and agreed that many patients could receive Minor Oral Surgery services in a Primary Care setting as long as the dental practice had adequate equipment and the dental practitioner to perform the treatment had the necessary skills and qualifications.

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2.3

Aneurin Bevan University Health Board successfully commissioned two Personal Dental Services contracts from dental practices based in Caerphilly and Newport. Since developing these two new services, the Health Board have not only commissioned contracts for GDP referrals to be directed to the Practices concerned but also developed contracts for patients to be released from the Secondary Care waiting list (Secondary Care Pull) to be treated in the Primary Care setting. This has meant that the Referral to Treatment Times (RTT) target has been met in Secondary Care during the past two years. The service has also been extended to provide Minor Oral Surgery under conscious sedation with one of the Providers.

The table below provides a breakdown of Secondary Care referral data and GDP to GDP referral data.

Table 5

Minor Oral Surgery Secondary Care 2014/15 2015/16 2016/17 Total no of referrals pulled from SC 1,546 1,154 - Total no of referrals treated & completed 632 520 - Total no of referrals returned to HDS 179 80 - GDP Total no of referrals 1,304 2,041 2,879 Total no of referrals treated & completed 766 1,573 1,903 Total no of referrals returned to GDP 79 156 651

It should be noted that with effect from 1st April 2016 no further ‘pulls’ from the Secondary Care waiting list has taken place.

However, the table above demonstrates that the service is being well utilised with increased referrals from General Dental Practitioners. The Health Board increased the contract values by £209,000.00 during 2016/17 to reflect the level of need for the service.

Since developing the new services, the Health Board’s Dental Advisors have audited the referrals being treated in Primary Care to ensure their appropriateness but also to provide some educational training to the higher referring Practices. The Health Board has also conducted regular Patient Questionnaires to establish the levels of patient satisfaction with the new service provision. The level of patient satisfaction is currently running at between 97 and 100 %.

In addition to the Primary Care Team monitoring the contract in line with NHS PDS Regulations 2006, the Division will work closely with ABCi in order to provide further analysis of the service.

Aneurin Bevan University Health Board developed a new robust Secondary Care Oral Surgery referral form for clinicians to use from 1st April 2016,

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2.3 when making referrals in to Secondary Care. Therefore, it is anticipated that this will continue to support the RTT targets as appropriate referrals to secondary care will only be accepted.

Referrals to the Primary Care Minor Oral Surgery service continue to be made directly by clinicians.

3.10 Sedation Services Sedation services are provided to patients for many different clinical reasons.

There is disparity in how sedation services are provided and funded across the Health Board. The Community Dental Services team currently triages child General Anesthetic sedation referrals, signposting referrals to the appropriate dental provider.

The Health Board will be establishing a Task and Finish Group to review all dental contracts that undertake sedation services in 2017/18.

Looking ahead to 2017/18 the Division will:

 Continue to provide a full Occupational Health Service for General Dental providers and their staff;  Continue to monitor the Minor Oral Surgery contracts and ensure General Dental Provider referrals for minor oral surgery are appropriate and in accordance with the pathway. In addition, work collaboratively with ABCi in order for further analysis to be undertaken;  To undertake a full review of sedation services.

3.11 Local Oral Health Action Plan The Health Board continues to work towards meeting the targets of the Local Oral Health Plan (LOHAP) in conjunction with community and hospital colleagues, reporting periodically to the Board, Welsh Government and also the Integrated Oral Health Strategic Group.

One of the objectives of the plan was to engage with stakeholders and patients. The Health Board has therefore devised a patient leaflet informing patients on how to access dental services etc. Since its development, the content and format of the leaflet has been agreed by the Integrated Oral Health Strategic Group.

3.12 Bariatric Chair Access Aneurin Bevan University Health Board has commissioned the use of a Bariatric Chair following the opening of the Blaenavon Resource Centre which opened in September 2014. A Bariatric Chair is also used in Clytha Clinic, Newport. A Referral Pathway has been developed to receive referrals for patients exceeding 23 stones.

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2.3 Aneurin Bevan University Health Board has also updated the audit undertaken in 2014 of the weight bearing load of all the dental chairs across Aneurin Bevan University Health Board. The audit is undertaken in order to ease the process of cross referrals between Practices for patients that exceed the weight limit of their existing Practice chairs. Practices that are upgrading their surgeries are also encouraged to consider purchasing larger weight bearing chairs.

3.13 Restorative Service Since September 2014 the Health Board has commissioned three sessions of this service per month from University Hospital of Wales Dental Hospital. This has been secured on a regular basis going forward. Practices have been notified of the referral criteria to the service which will continue until a more local service is developed.

3.14 CoMPASS NHS Dental Services developed a new IT system which allows Health Board employees and Dental Practitioners to view activity levels and payments and update their records. The system went live in February 2016.

Looking ahead to 2017/18 the Division will:

 Work with the Scheduled Care Division and the Dental Hospital Wales to access assessment and treatment to restorative services for Gwent residents on a long term basis.  Work with Dental Services to continually monitor the CoMPASS system.

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2.3 4 Community Pharmacy Services

4.1 Strategic Context Community Pharmacists are Independent Contractors who deliver National Health Services via a nationally negotiated Contract.

Services are provided within a contractual framework which has three elements:

 Essential services – which must be provided to all patients  Advanced services – may be provided to all patients subject to meeting accreditation requirements  Enhanced services – commissioned by Health Boards to meet local need

4.2 Operational Context There are 130 community pharmacy premises across the Aneurin Bevan University Health Board area, a mix of large corporate providers and small independent contractors serving local communities:

The table below shows the number of community pharmacies per locality:

Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent Number of pharmacy 16 43 18 32 21 130 premises

4.3 Governance Arrangements in Community Pharmacy Services The following groups exist which specifically lead on providing assurance with regards the Community Pharmacy Contract.

Community Pharmacy Liaison Group:  Chaired by the Divisional Director of Primary Care and Community Services.  Representation from Primary Care Directorate, Medicines Management Directorate and Community Pharmacy Wales.  Provides a forum for communication between the Health Board and their representative body.

Gwent Pharmaceutical Applications Committee:  Statutory committee, chaired by non-officer member, meets as required.  Representation from non-officer members and Primary Care and Community Services Division with support and advice from the Shared Services Partnership Contractor Services; a representative from Community Pharmacy Wales and Local Medical Committee are invited to attend but do not participate in decision-making.

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2.3  The committee takes decisions, in accordance with 2013 Regulations, on applications to open new pharmacy or dispensing premises and for minor relocations.

Local Intelligence Network:  Statutory committee, chaired by the Accountable Officer (Medical Director).  Meets quarterly.  Membership is multi-agency and, in addition to Aneurin Bevan University Health Board professional representation, includes the police, pharmacy inspector, Counter Fraud Service, Health Inspectorate Wales and other Local Intelligence Network representatives.  Monitors arrangements by General Practitioners and community pharmacists for prescribing, storage, dispensing and destruction of all Controlled Drugs and maintains a ‘concerns’ log.

Probity/Professional Regulation  Regulation is provided through the General Pharmaceutical Council as there is no Welsh Performers’ List for community pharmacists, where concerns cannot be managed at a local level; they are referred directly to the General Pharmaceutical Council.

4.3.1 Assurance in Community Pharmacy Services To ensure community pharmacy contractors comply with the Terms of Service set out in the NHS (Pharmaceutical Services) (Wales) Regulations 2013. The Health Board has developed a monitoring policy to ensure Community Pharmacies comply with the regulations and to reduce any risks.

In 2016/17, the monitoring process involved:

 A triennial contract monitoring visit to the community pharmacy by members of Health Board.  Community Pharmacies completed a yearly on-line Clinical Governance and Information Governance Toolkit. These are reviewed by the Health Board and for any indicator(s) which the contractor does not comply with, a report is sent to implement the required indicator(s).

Each community pharmacy will receive a contract monitoring visit once every three years, the Health Board will visit approximately one third of pharmacy contractors each year.

An additional visit may be triggered in exceptional circumstances, should concerns be raised following a significant event or other concerns expressed regarding the contractor or non completion of the on-line toolkits.

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2.3 4.3.2 Monitoring Process All Community Pharmacies ware advised to complete the on-line toolkits by March of that financial year and the results of the toolkits are received by the Health Board from Welsh Government in June of that financial year. The Health Board will review each toolkit and any indicators that are incomplete or not met, result in an “Action Report” being sent out to the contractor to implement action within the required time frame. Community Pharmacies have one month to complete any actions identified and return the completed action list to the Health Board. If the report is not returned or actions not implemented a monitoring visit will be arranged.

The initial role of the Health Board would be to support the contractor in achieving compliance.

For the community pharmacy that did not complete the Clinical Governance on-line toolkit, a paper copy was sent for them to complete within one month. If the community pharmacy fails to submit their report then a monitoring visit is arranged.

4.3.3 Contract Monitoring Visit Process A representative sample of approximately one third of pharmacies (following the rolling program) will receive a contract monitoring visit each financial year. Priority will be given to pharmacies meeting the following criteria:

 Non-completion of clinical governance toolkit – this will result in an automatic monitoring visit.  There are significant actions from previous annual visits to be followed up.  There have been complaints about the level of service.  There have been significant developments at a pharmacy e.g. major shop refit, re-location or change of ownership etc.

Every pharmacy in the Health Board must be visited at least once every three years. The Health Board monitoring visit is to ensure each Community Pharmacy Contractor complies with the Terms of Service set out in the National Health Service (Pharmaceutical Services) Regulations 2013. This is split into two areas:

Essential Services: Each Essential Service specification which includes Dispensing, Repeat dispensing, Waste, Healthy Lifestyle, Signposting, Support for Self Care and Clinical Governance have a number of indicators which each Community Pharmacy needs to implement (the majority of the indicators mirrors the NHS (Pharmaceutical Services) (Wales) Regulations). An example of an indication within each essential service is Standard Operating Procedures.

Other examples of indicators:

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2.3 Dispensing Essential Service: Does the pharmacy have Owing Procedure?

Repeat Dispensing: Secure storage for Batch Header and Issues.

Waste: Pharmacy complies with Environmental Agency Regulations.

Healthy Lifestyle: Does the pharmacist record advice given? Does the pharmacy have a range of patient leaflets? Does the Pharmacy have Signposting Book to refer patient to other organisations if the pharmacy cannot provide the advice, treatment or support to the patient?

Support for Self Care: Does the Pharmacy record (when appropriate) advice given to patients?

Clinical Governance: Near Miss Log, Appraisal Procedure

Advanced Services: This service includes Medicines Use Reviews (MURs) and Discharge Medicines Reviews (DMRs). The MURs are conducted with a patient and accredited pharmacists help the patient use their medicines more effectively. The DMR is conducted with the patient and pharmacist to provide support to patients recently discharged between care settings, ensuring that changes to medicines are followed up in the community.

These services aim to:

 lead to a reduction in risk of medication errors and adverse drug events  improve communications between healthcare professionals  increase patient involvement in their own care and to ensure they understand medication they are taking  reduce medicines wastage  contribute to avoiding medicines-related admissions to hospitals or care homes  better use the skills of pharmacists in optimising medicines use.

Any recommendations of the MURs or DMRs which are made to prescribers may also relate to the clinical or cost effectiveness of treatment.

The Health Board’s monitoring requirement for the advanced services is to ensure that the Community Pharmacies are complying with the regulations. For example each consultation room within community pharmacies are checked to ensure the room complies with the required standards (confidentiality, sign on the room, seating within the room for the patient and pharmacist).

At the end of the financial year 2016/17, all pharmacies had completed the toolkits and 35 community pharmacy visits were conducted. All of these community pharmacies were compliant with the regulations.

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2.3

Looking ahead to 2017/18 the Division will:

4.4 Access to Community Pharmacy Services The table below provides a summary of weekend and late night access.

Table 6

Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent

Number of 16 43 18 32 21 130 pharmacy premises

Number open on 13 31 17 22 13 96 Saturdays

Number open on 0 1 2 4 1 8 Sundays

Sunday Rotas 4 5 1 6 7 23

4.5 Enhanced Services The Health Board commissions a number of Enhanced Services to improve health outcomes, access to services locally and ensure equity.

The following provides a summary of the current Enhanced Services commission:

4.5.1 Local Enhanced Services: Supervised Administration of Medicines This service enables community pharmacies to assist users to remain healthy and harm free. The community pharmacists will have an agreement with the client for them to attend the pharmacy for their supply of opiate substitutes to control or withdraw addiction. This helps to reduce/avoid availability of these medicines in the community and help clients with healthcare issues around this area of specialism.

Service Specification requirements for Directly Observed Therapy This service enables community pharmacies to help patients comply with the agreed treatment plan by:

 dispensing in specified instalments  ensuring each supervised dose is correctly consumed by the patient for whom it was intended to ensure that patients are 49

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2.3 treated and remain healthy

Needle Exchange Services  Pack Service The primary aim of a community pharmacy needle and syringe exchange scheme is to help reduce the spread of HIV, Hepatitis C and other blood- borne diseases amongst injecting drug mis-users by providing clients with convenient access to a pack of sterile injecting equipment and a facility for the safe disposal of used equipment, therefore reducing the risk in the community.

 Pick and Mix Needle Exchange Service The aim of the pilot pick and mix needle exchange scheme is for community pharmacies to contribute to a comprehensive needle and syringe programme and to wider arrangements for harm reduction through the provision of an easy access and a user-friendly service for all injecting drug users which includes the distribution of loose injecting equipment, with verbal and written information on harm reduction at no cost to the patient.

Waste Reduction Service This enhanced service aims to reduce prescribing waste and over ordering of repeat medication by utilising community pharmacists and their support staff to ascertain directly from patients whether or not each item presented for dispensing is actually required.

Smoking Cessation Services  Level 2 Service This service is designed to link community pharmacy with the intensive behavioural support service provided by Stop Smoking Wales. Under this arrangement the community pharmacist will undertake to supply Nicotine Replacement Therapy to smokers who are receiving intensive smoking cessation behavioural support from Stop Smoking Wales.

 Level 3 Service The aim of this service will be to provide one to one motivational support and advice to smokers who are motivated to give up smoking. The service will help to increase the choice of NHS stop smoking services and increase access to nicotine replacement therapy. To provide an effective smoking cessation service to help patients access intensive behavioural support specialist services by utilising the expertise, locations and accessibility of community pharmacies.

 Pilot of a Smoking Cessation Level 3 PGD Varenciline Scheme The aim of this service is to increase the number of people giving up smoking across the ABUHB area and improve quit rates by including varenciline as a treatment via PGD. This will improve choice for patients who will be able to receive this treatment without seeing their GP.

 Community Pharmacy Smoking Cessation Reward Scheme

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2.3 Each pharmacy participating in the reward scheme will have to treat at least 30 clients from September 2016 – March 2017 and achieve 40% (four week quit rates) within this period. In achieving this target, the pharmacy will be rewarded an additional £250 on top of the current reimbursement fees.

Palliative Care Out of Hours Service This service is aimed at the supply of specialist palliative care medicines. The pharmacy contractor stocks an agreed range of specialist medicines and makes a commitment to ensure that users of this service have prompt access to these medicines at all times. The service is designed to provide a delivery service to patients within two hours.

Out of Hours Rota Service The purpose of this service is to extend pharmacies opening hours to ensure that Aneurin Bevan University Health Board has adequate service provision to cover weekdays, weekend and bank holidays to improve access for patients to receive their medication and advice.

Minor Ailment - Torfaen Borough This service allows patients to access specified treatment for selected common ailments, free of charge, following consultation with a community pharmacist and without the need to consult a General Practitioner.

Medication Administration Service This service requires the pharmacy to dispense and supply medication with a Medicines Administration Record (MAR) or Monitored Dosage System/MAR or Automatic Pill dispenser for patients identified to them by either a Community Resource Team or District Nursing Team or Social Services. The aim is to enable the patient to be cared for in their home environment who could potentially have been admitted to residential, nursing or hospital care because of problems associated with self-administration of medication.

Out of Hours Emergency Supply of Prescribed Medication The aim of the service is help reduce the demand of GPOOHs over the weekend to help patients obtain an emergency supply of their regular prescribed medication. Many patients find themselves without their regularly prescribed medication for a number of reasons and occasionally, usually at weekends, are unable to obtain a prescription from their GP before they are due to take their next dose. Most often these patients will contact the OOH service in order to obtain a prescription. These requests take up significant resources at OOH with demand peaking at weekends and bank holidays.

Looking ahead to 2017/18 the Division will:

 Increase the uptake of the enhanced services.  Evaluate the reward scheme for the Smoking Cessation Level 3 Service to increase the activity to meet Tier 1 target.

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2.3  Evaluate the pilot Smoking Cessation Level 3 Varenicline PGD and roll out to other pharmacies.  Increase activity for the Smoking Cessation Level 3 Service to meet the Tier 1 target.  Implement a pilot Asthma Review Service with community pharmacies in Torfaen South NCN.  Decommission the Torfaen Minor Ailment Scheme as this will be replaced with the National Common Ailment Scheme  Implement additional rota service for Sunday in Torfaen to support and reduce the burden on GP OOHs over the weekend.  Implement the Medication Administration Service across the Health Board.  Review the current rota service provision to ensure meeting patients and Health Board needs.  Review the need for a community pharmacy alcohol service to improve patients’ health outcomes.

4.5.2 National Enhanced Services Just in Case Scheme The service aims to provide (where clinically appropriate) a palliative care medicine pack to patients for whom it is anticipated that their medical condition may deteriorate into the terminal phase of illness. This service will help to improve access to palliative care medicines for patients who are at the end of their lives.

Emergency Hormonal Contraception This service is designed for pharmacists to supply Emergency Hormonal Contraception, when appropriate, to clients through a Patient Group Directive. The aim of the service is to improve access to emergency contraception and sexual health advice.

Flu Vaccination Scheme To provide influenza immunisation for those patients in locally agreed, at risk groups. This is to support the wider provision of influenza immunisation and increase the proportion of at risk individuals who receive immunisation.

Choose Pharmacy Platform – Common Ailment Scheme The service is designed to make the community pharmacy the first port of call for the provision of advice and, where necessary, treatment of common illnesses. The objective of the service is to improve access to consultations, advice and, where appropriate, medicines for common illnesses; encourage patients who would otherwise have visited a GP to visit the pharmacy instead; provide advice and, where necessary, treatment; and promote self- care, thereby increasing resilience.

Looking ahead to 2017/18 the Division will:

 Increase the number of community pharmacies providing Flu Vaccination Service Local Enhanced Service from 70 to 100.  Implement the Choose Pharmacy Platform including Common Ailment Service with community pharmacies throughout all localities within52 the Health Board as part of a rolling programme in collaboration with NWIS with Hub pharmacies.

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2.3

4.5.3 Number of Community Pharmacies commissioned to provide enhanced services The table below illustrates the number of community pharmacies commissioned to provide the enhanced service per locality:

Local Enhanced Services

Blaenau Monmouth- Caerphilly Newport Torfaen Total Gwent shire

Supervised Administration of 11 25 14 26 15 91 Medicines

Service Specification Do not Do not Do not Do not requirements for commission commission commission 3 commission 3 Directly this service this service this service this service Observed Therapy

NES Pack Service 4 3 3 1 3 14

NES Pick and Mix 1 1 1 1 1 5 Service

Waste Reduction 6 10 8 22 8 54 Service

Medicines Do not Do not Administration 5 25 11 commission commission 41 Record Service this service this service

Smoking Cessation 10 22 10 22 12 76 Services-Level 2

Smoking Cessation 7 18 8 14 13 60 Services-Level 3

Pilot PGD Do not Smoking 4 3 2 commission 1 10 Cessation Level 3 this service Service

Smoking Reward 1 4 2 3 1 11 Scheme

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2.3 Palliative Care Out of Hours 1 4 2 3 1 11 Rota Service

Out of Hours 13 22 8 12 12 67 Rota Service

Newport Do not Do not Do not Additional commission commission commission 6 0 6 Sunday Rota this service this service this service

Do not Do not Do not Do not Minor Ailment - commission commission commission commission 21 21 Torfaen Borough this service this service this service this service

Medication Do not Do not Do not Administration commission commission commission 15 20 35 Service this service this service this service

Out of Hours Emergency Supply of N/A 1 1 3 1 6 prescribed medication

Pilot- Asthma Review Jan-Mar 1 1 1 1 1 5 2016

National Enhanced Services

Blaenau Monmouth- Caerphilly Newport Torfaen Total Gwent shire

Just in Case 7 21 9 17 14 68 Scheme

Emergency Hormonal 14 30 11 26 15 96 Contraception

Flu Vaccination 9 23 9 21 14 76 Scheme

4.6 Markham

On 8 July 2015, the Local Medical Committee submitted a request to the Pharmaceutical Applications Committee to review the classification of the areas surrounding Argoed, Hollybush, Manmoel and other surrounding areas due to Markham village being re-classified from urban to rural. This request was presented and agreed by Aneurin Bevan Pharmaceutical 54

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2.3 Application Committee (ABPAC) in September 2015. A site visit was conducted on 13 January 2016 to review the classification of these areas. On 8 March 2016 members of ABPAC reviewed the information provided from the site visit, the LMC request and comments made from interested parties.

A report was presented to Board in May 2016, with the recommendations that Argoed and Hollybush remain ”urban” and Manmoel be classified as “rural”. These recommendations were ratified by the Board. All interested parties, including the Assembly Member and Member of Parliament were informed of the decision.

Welsh Government has informed the Health Board that an appeal has been made on the decision of the classification of the areas. Welsh Government will now review all information and inform the Health Board of the outcome within two years. The Board has decided that no further action will be taken until a decision has been made of the appeal.

Furthermore, the appeal made to Welsh Government regarding the Health Board decision to grant the pharmaceutical application from the local provider to open a pharmacy in Markham has been rejected. The local provider has 12 months from August 2016 to secure premises.

Looking ahead to 2017/18 the Division will:

 Await the decision of Welsh Government  Local provider to confirm a premise in Markham

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2.3 5 Community Optometry Services

5.1 Strategic and Operational Context There are 68 community optometry premises across Aneurin Bevan University Health Board area, a mix of corporate providers and small groups and independent practices serving local communities.

They provide a wide range of all-Wales National Health Services including sight tests through the General Ophthalmic Services and eye examinations under the Wales Eye Care Services including Eye Health Examinations and the Wales Low Vision Service. There are local enhanced services that provide mobile sight testing in hospitals and assessments in community optometry practices for patients who have glaucoma or ocular hypertension or who have had cataract surgery.

Domiciliary optometry services are available to patients who are unable to leave their own home unaccompanied. They are usually referred to as ‘mobile services’ because they are sometimes provided away from a patient’s place of residence e.g. at a day centre. 21 practices offer mobile services and there are additionally three mobile providers that do not have practice premises.

Optometrists assess patients’ vision, issue optical prescriptions and provide optical vouchers for appliances such as spectacles and contact lenses. They also diagnose diseases and abnormalities of the eye and manage many eye conditions including acute eye conditions and low vision.

General Optical Service sight tests and Wales Eye Care Services are funded from a national budget (which is non-cash limited to Local Health Boards). The local enhanced services are funded by Aneurin Bevan University Health Board.

The table below illustrates the number of community optometry premises per locality:

Blaenau Caerphilly Monmouthshire Newport Torfaen Total Gwent

Optometry 8 20 15 15 10 68 Premises

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2.3 The table below highlights the number of practices providing services:

Mobile General Wales Glaucoma General Wales Optical Low Local Optical Eye Care Local Vision Enhanced Services Services Enhanced Service Service Service

Blaenau Gwent 8 3 8 7 1

Caerphilly 20 5 19 13 1

Monmouthshire 15 2 11 6 1

Newport 15 3 12 5 2

Torfaen 10 2 10 4 1

Total 68 15 60 35 6

5.2 Optometry Governance Structure All optometrists are registered with the General Optical Council. All optometry practices are inspected on behalf of the Health Board prior to being open to the public. These inspections are carried out by the National Health Service Wales Shared Service Partnership in line with the General Ophthalmic Services Regulations and include post-payment verification to ensure financial probity.

However, the Health Board recognises that robust governance is essential and this is achieved through the Eye Care Pathway Group.

Eye Care Pathway

 Chaired by General Manager for Primary Care and Community Services Division  Meets quarterly  Representation from Primary Care and Community Services Division, Scheduled Care Division, South East Wales Regional Optometric Committee and Gwent Community Health Council  Discusses eye care services and associated matters that affect the population of Gwent  Oversees the development of operational plans to achieve policy direction  Works in collaboration to ensure that high quality primary care, acute and community care eye services continue to be delivered.

5.3 Access to Optometry Services The Health Board has prioritised the development of services to support the needs of vulnerable people, particularly older people, and reduce the need for unnecessary visits to hospital.

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2.3 Currently the Health Board commission one local enhanced service:

Mobile Sight Tests in Hospitals Local Enhanced Service The aim of this Local Enhanced Service is to enable contractors and assistants listed to provide Mobile General Ophthalmic Services to provide sight tests to hospital in-patients which enables patients who are effectively residents in Aneurin Bevan University Health Board hospitals to have access to primary eye care services.

This Local Enhanced service provided mobile sight tests for five patients during 2016/17 who were effectively resident in hospital.

Due to the success of the Glaucoma Local Enhanced Service, the Health Board was successful in securing funding via Welsh Government to hold Glaucoma Ophthalmic Diagnostic Treatment Centre (ODTC) services. Six contracts were awarded across the Health Board for Glaucoma ODTCs. This service allows care close to people’s homes to increase capacity and reduce waiting times in ophthalmology by enabling patients with glaucoma and ocular hypertension to have assessments with community optometrists instead of attending hospital clinics.

Glaucoma ODTC Service The aim of this service is to provide assessment for people with glaucoma or ocular hypertension, who are under the care of the Ophthalmic Surgeons and have experienced delays with their follow up assessments. The results of the patients’ assessments are reviewed by the Ophthalmic Surgeons who determine the patient’s further care. From April 2016 to March 2017, 2483 patients were invited for an assessment and 1837 received their follow-up assessment.

Looking ahead to 2017/18:

 Ongoing implementation of Welsh Government’s National Ophthalmic Plan focusing on improving eye health for our population by ensuring adequate access across services and delivering high quality, effective and efficient eye health care to all locally in the primary care setting wherever possible.  Ongoing improvements to the eye care pathway through the Wales Ophthalmic Planned Care Board and Eye Care Pathway Group.  Development of services at cluster level with NCN lead.  Appointment of new provider for optometry services in prisons.  Scoping independent prescribing possibilities in primary care optometry.

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2.3 6 Primary Care Estates

Improving capacity in Primary Care estates is fundamental to the delivery of the primary care agenda.

6.1 Schemes Brynmawr Development Agreements for Lease were signed in October 2016 and work commenced on site November 2016. Work is progressing, with practical completion expected on 28 November 2017. Following this, there will be a two week lead-in period with services being provided from the building before the end of the year.

Llanbradach Following the appointment of the Third Party Developer, building plans and the schedule of accommodation are in the process of being finalised. A Full Business Case will be presented to the Board in September 2017 to gain approval for the development to proceed.

Indicative timescales for completion of the proposed development, if approved by the Board, will be February 2019.

Tredegar Health and Well-being Centre A multi-agency group has been established and initial discussions are underway with regards to developing an appropriate service model for the Tredegar area and ultimately the Tredegar Health and Well-being Centre. Outline proposals will be presented to the Board in September 2017 in order to seek approval to enter into discussions with the Welsh Government to explore the possibility of taking the scheme forward as a capital development.

Newport East Resource Centre Proposals are currently being developed for the Newport East Resource Centre. Outline proposals will be presented to the Board in September 2017 in order to seek approval to enter into discussions with the Welsh Government to explore the possibility of taking the scheme forward as a capital development.

A workshop is being planned for the beginning of August 2017 to identify and agree a proposed service model for the development. It is proposed the development will include three GP Practices, Community Services and other services to provide a Health and Well-Being Centre for the East of Newport.

6.2 Improvement Grants The NHS Wales Premises Directions (2015) sets out a range of criteria which must be considered when approving Improvement Grants. Amongst other consideration, this includes:

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2.3  Equality Act 2010 compliance  Health and Safety requirements, eg fire precautions, emergency planning  Infection Control or decontamination requirements

Following Board approval in May 2016, a number of major and minor improvement grants have been progressed, utilising the recurring £300k allocation.

In addition to this, the Welsh Government funded a further £100k to progress an agreed list of minor improvement grants.

Major Improvement Grants The following practices’ Improvement Grants were prioritised and approved to progress with their application in 2016-17, in line with the NHS Wales Premises Directions (2015).

Cwmbran Village Surgery The Improvement Grant for Cwmbran Village is to provide a large extension to the existing premises. Planning application approved with minor conditions. The work on the improvements commenced March 2017 with the majority of the work to be undertaken during 2017/18.

Castle Gate Medical Practice The Improvement Grant for Castle Gate Surgery provides an internal reconfiguration of the dispensary in order to provide more capacity within the building. Work commenced on 6 February 2017 and is due to be completed during August 2017.

Usk Surgery Usk Surgery was identified for development in 2016/17. However, the practice has since informed the Health Board that they are not in a position to progress at present. The Health Board will continue to support Usk Surgery to develop plans for their future improvement grant requirements.

The table below details the costs incurred in 2016/17 supporting practices using the major improvement grant funding:

Minor Improvement Grants

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2.3 The table below details those practices that were approved to proceed with Improvement Grants during 2016/17.

6.3 Priorities for 2017 -2018 In order to identify schemes for consideration for 2017/18, the Health Board used the following approach:

 Those schemes included in the 2016/17 prioritisation exercise which are not yet completed due to the complexities of the schemes  Review of Practice Development Plans (PDPs) and Neighbourhood Care Network (NCN) Plans  Discussions with NCN Leads to identify priorities in their areas

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2.3  Willingness of practices to proceed and fund new major or minor improvement grants.

For 2017/18, the Health Board has allocated its £300k funding to support the completion of the Major Improvement Grants that commenced in 2016/17. These are:

 Cwmbran Village Surgery - £67,000  Castle Gate Surgery - £230,000

Following the completion of the Improvement Grants, the Premises Directions clearly states that, should the premises no longer be used for NHS service provision within a given period of time (dependent on the value of the Grant), the Practice are to repay the financial investment made by the Health Board or Welsh Government.

In addition to this, in January 2017, the Welsh Government notified Health Boards that non recurrent funding of £1.8m (total) had been approved by the Cabinet Secretary for use for Improvement Grant schemes for 2017- 2018 for Wales. As a result, officials were tasked with determining additional priorities, estates requirements and funding proposals with organisations.

In order to agree priorities and allocate funding accordingly, Health Boards have been asked to provide details of their priority issues for improvement grants for 2017-18, with details of the requirements specifically around urgency of need, sustainability, infection control etc.

In response to this, Aneurin Bevan Health Board submitted a request to the Welsh Government requesting the sum of £420,627 for two areas of investment. These were:

Tudor Gate Surgery - £370,627.37 (Health Board contribution) The Improvement Grant is to improve the primary care service provision and practice arrangements. The proposal will reconfigure the internal clinical space, ensure compliance under the Equality Act 2010 and address any issues in relation to Infection Control. The work will be undertaken in compliance with Welsh Health Building Note (WHBN 36).

Not only is the Tudor Gate development a strategic premises within the North Monmouthshire NCN area, there was a willingness by the practice to financially contribute to the extensive works which will be undertaken at the practice.

Store and Scan - £50,000 The Health Board applied for an additional £50,000 to support the improvement of premises following the removal of medical records.

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2.3 The Welsh Government supported the application for the Tudor Gate Surgery development, but was unable to support the additional £50k for store and scan.

6.4 Store and Scan The Patient Medical Record Storage and Scan Service provides off-site secure storage and management of live patient medical records. This is for all GP practices within Wales and is run in partnership with NHS Wales Shared Services Partnership.

Aneurin Bevan Health Board submitted an Efficiency Through Technology Fund (ETTF) bid for funding this in 2016/17.

Subject to this, the Division agreed to fund the set up and running costs for all practices within Gwent, including the ongoing yearly revenue costs.

The Store and Scan service will store records securely at Mamhilad Park Estate and will be managed in line with defined standard operating procedures to support the movement of records. Each medical record will be catalogued electronically, with the movement of records tracked using the National Health Authority.

Ultimately, this will also support the strategic aims identified with the upcoming roll-out of GP2GP, when, should there be a legislative change, the Patients Medical Record, will no longer be required to follow the patient.

The scheme commenced in January 2017 and will be rolled out to all ABUHB practices on a phased basis over a one year period, with an estimated completion of December 2017. Practices will be phased in line with Health Board’s Estates Priorities for new builds and improvement grants and any impacting sustainability and access issues with practices throughout Gwent.

22 practices participated in Phase 1 of the rollout during the final quarter of 2016/17.

The remaining 50 practices will be supported with this initiative throughout 2017/18.

Costs There are 604,626 registered patients within ABUHB.

Costs provided are inclusive of initial set up costs and the ongoing revenue costs of providing the service. (This however does not include costs for additional staff time in order to prepare the medical records).

Total costs =

£283,842 – Year 1 – Programme including initial set up costs £148,980 - Year 2 – Ongoing yearly revenue costs

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2.3

This figure could potentially decrease, based on economies of scale.

Throughout 2017/18 the Division will develop and prepare a programme of schemes including minor and major improvement grants and progress with the Third Party scheme for Aber Valley (prioritised in 2016/17).

Looking ahead to 2017-18 the Division will:

 Complete the build of Brynmawr Resource Centre by the end of 2017;  Develop an Initial Proposal Document for Newport East and Tredegar Health and Well-being Centre;  Deliver the Improvement Grant schemes identified for 2017-18.  Develop criteria for considering Health Board lease agreements.  Complete the Store and Scan project.  Identify, prioritise and agree proposals for 2018-2019

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2.3 7 Primary Care Priorities 2017/18

This section highlights the main priorities for Primary Care Team for 2017/18, identified by the Division.

7.1 General Medical Services

 Continue to support with practices identified via the sustainability framework applications  Develop a plan to work with those identified “at risk” through the sustainability framework risk matrix.  Continue to support and develop the managed practices  Develop PCOST and consider/test new roles  Embrace the emerging model  Support practice mergers and/or vacant practice process  Develop proposal for clinical lead roles  Implement actions identified in the All Wales Workforce Plan  Continue to review and report on the workforce data for GP practices to ensure effective succession planning  Continue to report to the Welsh Government and identify further steps that are required to deliver training programmes  Continue to identify and address workforce related issues  Support recruitment and workforce development  Manage the Vacant Practice process  Continue to support practices who submit applications to change their boundary  Continue to support practices with branch surgery closure requests  Continue to work with practices to ensure the optimum standards of access to General Medical Services are available to patients throughout the core hours of 8.00 am to 6.30 pm.  Review the extended hours LES  Embed the Reasonable Access principles  Continue to improve General Practitioner Access standards across the Health Board and encourage the uptake of My Health On Line for both appointments and repeat prescriptions.  Progress the Optimising Access in General Practice work programme  Evaluate the findings and recommendations of the Operasee report and determine the next steps for the Access QI work programme  Continue to monitor QOF  Continue to work with practices to implement the new anticoagulation service model following the introduction of the new DES  Monitor the Extended Skin Service  Review the minor surgery cap activity  Maximise uptake in childhood immunisation  Improve uptake of Mental Health and Learning Disabilities DES  Finalise the review of the Alternative Treatment Centre policy  Implement the revised enhanced services in accordance with revised national guidance Care Homes and Diabetes

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2.3  Review the enhanced services activity and liaise with practices to promote and improve uptake  Continue to support the delivery of services to Syrian Refugees  Review and facilitate inter practice referrals for those enhanced services that are not provided by all practices  Review the Childhood Immunisations Service Level Agreement  Continue to ensure all General Practices receive an annual contract review  Continue to ensure Primary Care Nursing Team and Quality and Patient Safety Team input into the annual review process and visits  Continue to support the use of the Clinical Governance Practice Self Assessment Toolkit.  Engage in NCN collaborative working

7.2 General Dental Services

 Continue to engage with the new Integrated Oral Health Strategic Group  Facilitate the Dental QPS CPD Programme  Continue to comply with the Public Health Wales ‘Model Dental Governance Framework for General Dental Services’ and ‘Delivering NHS Dental Services more Effectively’ to ensure a robust process is in place for quarterly and annual monitoring  Support the Primary Care Quality and Patient Safety team with regards to the HIW monitoring process  Maintain the monitoring of Quality Assurance System uptake across all Dental practices  Continue the Annual Review Visits to Dental Practices (3rd cycle)  The Division recognises the access issues and has invested an additional £75,000.00 to increase dental access. Therefore, six Personal Dental Service contracts have been established totalling £250,000.00 additional spend  The Division has received a further £300,000.00 in 2017/18 from Welsh Government to address the access issues. The Primary Care Team is currently reviewing the access issues in order to target the areas in highest need/demand for dental services  The Division will engage with Welsh Government and Dental Public Health Wales and support practices during the contract reform process  Continue to monitor Orthodontic Contracts in line with recommendations made by the Managed Clinical Network Group for Orthodontics  Continue to monitor the New Domiciliary service ensuring access is sufficient for vulnerable people across the Health Board  Re-tender the service in 2017/18  Continue to provide a full Occupational Health Service for General Dental providers and their staff;  Continue to monitor the Minor Oral Surgery contracts and ensure General Dental Provider referrals for minor oral surgery are

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2.3 appropriate and in accordance with the pathway. In addition, work collaboratively with ABCi in order for further analysis to be undertaken  To undertake a full review of sedation services  Work with the Scheduled Care Division and the Dental Hospital Wales to access assessment and treatment to restorative services for Gwent residents on a long term basis  Work with Dental Services to continually monitor the CoMPASS system.

7.3 Community Pharmacy Services

 Implement the Community Pharmacy Monitoring Policy  Continue to robustly monitor the performance of Community Pharmacies across ABUHB via the Annual Monitoring Review process  Implement MUR/DMR Housebound and MUR policies  Develop a Repeat Dispensing Audit  Increase the uptake of the enhanced services  Evaluate the reward scheme for the Smoking Cessation Level 3 Service to increase the activity to meet Tier 1 target  Evaluate the pilot Smoking Cessation Level 3 Varenicline PGD and roll out to other pharmacies  Increase activity for the Smoking Cessation Level 3 Service to meet the Tier 1 target  Implement a pilot Asthma Review Service with community pharmacies in Torfaen South NCN  Decommission the Torfaen Minor Ailment Scheme as this will be replaced with the National Common Ailment Scheme  Implement additional rota service for Sunday in Torfaen to support and reduce the burden on GP OOHs over the weekend  Implement the Medication Administration Service across the Health Board  Review the current rota service provision to ensure meeting patients and Health Board needs  Review the need for a community pharmacy alcohol service to improve patients’ health outcomes  Increase the number of community pharmacies providing Flu Vaccination Service Local Enhanced Service from 70 to 100.  Implement the Choose Pharmacy Platform including Common Ailment Service with community pharmacies throughout all localities within the Health Board as part of a rolling programme in collaboration with NWIS with Hub pharmacies  Await the decision of Welsh Government  Local provider to confirm a premise in Markham

7.4 General Optometry Services

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2.3 and efficient eye health care to all locally in the primary care setting wherever possible  Ongoing improvements to the eye care pathway through the Wales Ophthalmic Planned Care Board and Eye Care Pathway Group  Development of services at cluster level with NCN lead  Appointment of new provider for optometry services in prisons  Scoping independent prescribing possibilities in primary care optometry

7.5 Primary Care Estates

 Complete the build of Brynmawr Resource Centre by the end of 2017  Develop an Initial Proposal Document for Newport East and Tredegar Health and Well-being Centre  Deliver the Improvement Grant schemes identified for 2017-18  Develop criteria for considering Health Board lease agreements  Complete the Store and Scan project  Identify, prioritise and agree proposals for 2018-2019

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Appendix 1 2.3

Achievement Against 2016/17 Primary Care Objectives

Objectives Status

General Continue to work with practices to ensure the Ongoing Medical optimum standards of access to General Services Medical Services are available to patients throughout the core hours of 8.00 am to 6.30 pm. Continue to improve General Practitioner Ongoing Access standards across the Health Board and encourage the uptake of My Health On Line for both appointments and repeat prescriptions. Progress the Optimising Access in General Ongoing Practice work programme. Relaunch Access Quality Improvement Scheme Complete to practices who did not participate in cohort 1. Manage the Vacant Practice process. Ongoing Continue merger discussion with practices. Complete Continue to support practices through the Ongoing Sustainability Framework. Continue with the interim service model for the Ongoing Primary Care Anticoagulation Service for INR Level 4, followed by INR level 3, subject to the revised specification being issued. Review the minor surgery cap activity. Complete Review enhanced services in accordance with Ongoing revised national guidance. Support the delivery of services to Syrian Ongoing Refugees. Implement the Childhood Immunisation Team, Complete where procured, and deliver a robust training programme to those practices providing the service for the first time by 30 September 2016. Continue to ensure all General Practices receive Complete a review. Continue to ensure Primary Care Nursing Team Complete and Quality and Patient Safety Team input into the annual review process and visits. Continue to support the use of the Clinical Complete Governance Practice Self Assessment Toolkit. General Continue to engage with the new Integrated Ongoing Dental Oral Health Strategic Group. Services Facilitate the Dental QPS CPD Programme. Complete

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2.3 Continue to comply with the Public Health Complete Wales ‘Model Dental Governance Framework for General Dental Services’ and ‘Delivering NHS Dental Services more effectively’ to ensure a robust process is in place for quarterly and annual monitoring.

Ensure HIW visits continue in 2016/17 for those Ongoing not conducted during 2015/16. Maintain the monitoring of Quality Assurance Complete System uptake across all Dental practices. Continue to monitor Orthodontic Contracts in Complete line with recommendations made by the Managed Clinical Network Group for Orthodontics. Continue to monitor the New Domiciliary Ongoing service ensuring access is sufficient for vulnerable people across the Health Board. Undertake a further review of the Domiciliary Ongoing Service. Continue to provide a full Occupational Health Complete Service for General Dental providers and their staff. Continue to monitor the Minor Oral Surgery Complete contracts and ensure General Dental Provider referrals for minor oral surgery are appropriate and in accordance with the revised pathway. To undertake a full review of sedation services. Ongoing Work with the Scheduled Care Division and the Ongoing Dental Hospital Wales to access assessment and treatment to restorative services for Gwent residents on a long-term basis. Pharmacy Develop Community Pharmacy Monitoring Complete Policy Continue to robustly monitor the performance Complete of Community Pharmacies across ABuHB via the Annual Monitoring Review process Implement MUR/DMR Housebound and MUR Complete process Implement NOAC Multidisciplinary Audit Ongoing Evaluate the PPI Audit for 2015/16 Complete Extend the local enhanced service from 50 to all Complete community pharmacies that wish to apply for the service Develop and implement a reward scheme for Ongoing the Smoking Cessation Level 3 Service to increase the activity to meet Tier 1 target Evaluate the community pharmacy pilot Complete Asthma Review Service and seek approval to

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2.3 extend the Asthma Review Service as a Local Enhanced Service Increase the number of community pharmacies Complete to provide the Out of Hours Emergency Supply of prescribed medication Implement the Choose Pharmacy Platform Complete including Minor Ailments with community pharmacies Implement additional rota service for Sunday in Complete Newport to support and reduce the burden on GP OOHs over the weekend Increase the number of community pharmacies Complete providing Flu Vaccination Service Local Enhanced Service from 34 to all community pharmacies that wish to apply for the service To review how community pharmacies can Ongoing support GPs with INR Level 4 service To review the need of a community pharmacy Ongoing alcohol service to improving patients health outcomes Increase the number of Community Pharmacies Complete providing the enhanced services Optometry The Health Board is to be host for the funding Complete of the whole of Wales for the Eye Health Examination Wales (EHEW) Commission an additional three primary care Complete Glaucoma Ophthalmic Diagnostic and Treatment Centre contracts to reduce demand on hospital eye services, bring services close to home, within the areas of Blaenau Gwent, Monmouthshire and Caerphilly Localities. Commission a primary care Welsh Eyecare Complete Treatment for Age-related macular degeneration Ophthalmic Diagnostic and Treatment Centre contract to reduce demand on hospital eye service. Implement a pilot service via the NCN leads for Ongoing GPs to signpost patients to community optometry practices. Implementation of Welsh Government’s Ongoing National Ophthalmic Plan focusing on improving Eye Health for our population by ensuring adequate access across services and delivering high quality, effective and efficient eye health care to all locally in the primary care setting wherever possible. Estates Commence the build of Brynmawr Resource Ongoing Centre, with planned commencement on site Autumn 2016. 71

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2.3 Develop a full business case for Llanbradach Ongoing Primary Care Centre to present to the Board for approval. Develop an Initial proposal Document for Ongoing Newport East consideration by the Board in July 2016. Deliver the Improvement Grant schemes Complete identified for 2016-17. Develop criteria for considering Health Board Ongoing lease agreements. Progress the Store and Scan project. Ongoing

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Aneurin Bevan University Health Board

Proposed indicators to support the ABUHB priorities for Gwent Public Service Boards Well-being Plans

Purpose of the Report:

This discussion paper proposes a set of indicators for the agreed Aneurin Bevan University Health Board (ABUHB) priorities for the five Gwent Public Service Board Well-being Plans. These are intended for ABUHB representatives on PSBs and the ABUHB officers that are directly involved in drafting the PSB well-being plans.

Recommendation:

The Public Partnerships and Well-being Committee are asked to consider and provide feedback on:

 The proposed set of indicators for the ABUHB priorities for the Gwent Public Service Boards Well-being Plans

The Board is asked to: (please tick as appropriate) Approve the Report √ Discuss and Provide Views √ Receive the Report for Assurance/Compliance Note the Report for Information Only Executive Sponsor: Dr Sarah Aitken, Executive Director of Public Health Report Author: Miss Jennifer Evans Mrs Eryl Powell, Consultant in Public Health Report Received consideration and supported by : Executive Committee of the Board Public Team [Committee Name] Partnerships and Well-being Committee. Date of the Report: 25th October 2017 Supplementary Papers Attached:

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2 Background

In developing Well-being Plans, Public Service Boards (PSB) are required to demonstrate how PSB partners intend to work together as a system to develop and implement solutions to the complex challenges facing our communities now and in the future, while ensuring that success for one organisation does not accentuate the challenges facing other organisations. The statutory guidance on the development of PSB Well-being Plans sets out a requirement that before a PSB publishes its Well-being Plan it has to be approved by all members of the PSB. The Health Board is a core member of the five PSBs in Gwent and will need to approve the five PSB Well-being plans for the Gwent area.

To support ABUHB Board members with the approval process a set of four ABUHB priorities for the PSB Well-being Plans have been distilled from the 10 ABUHB Wellbeing Objectives that form part of the ABUHB Well-being Statement published in the ABUHB Integrated Medium Term Plan (2017/18- 2019/20). The priorities were selected on the basis that they can only be addressed successfully by working with PSB partners. Health Board priorities that can be tackled alone by ABUHB or by ABUHB working with just one other Public Body were not included. The developing Clinical Futures Level 1 programme will be an important vehicle for delivering on these priorities in conjunction with PSB partners.

The four priorities have been agreed by the Executive Team and Public Partnerships and Well-being Committee.

3 Proposed indicators for Aneurin Bevan University Health Board priorities for the five Gwent Public Service Board Well-being Plans

Following agreement of the four ABUHB priorities, the Public Partnerships and Well-being Committee requested that indicators were developed to support the priorities. The indicators presented in the table below reflect data that is readily available, much of which is taken from the Public Health Outcomes Framework, others come from NHS Wales Informatics Service (NWIS), Chronic Condition Registers (AUDIT+), Public Health Wales Observatory, Office for National Statistics and Welsh Cancer Intelligence and Surveillance Unit (WCISU). They are a mixture of indicators of ‘good health’ and ‘poor’ health, and so when the data is presented it will be important to be clear about which direction the indicators should be going in,

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for example, we’d want low birth weight to come down but children of a healthy weight to go up. The document in appendix 1 sets out more detail about each of the indicators, including the definition of what is measured, the geography at which it is available at and the frequency of publication.

ABUHB priorities for PSB Well-being Plans - Proposed indicators

Our aspiration is to: Reduce health inequalities and improve the health of people in Gwent by working with our partners focusing particularly on those in greatest need.

ABUHB priorities for PSB Proposed indicators Well-being Plans

Priority 1: To provide  Low birth weight children and young people with the best  Children age 4-5 years of healthy possible start in life weight or underweight  Tooth decay among 5 year olds

 Vaccination rates  Teenage conceptions

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Priority 2: To achieve  Adults who smoke impact on preventable heart disease, stroke,  Adults drinking above guidelines diabetes, cancer,  Adults eating five fruit or vegetable respiratory and liver portions a day disease.  Adults meeting physical activity guidelines  Working age adults of healthy weight

 Months of life lost due to alcohol

 COPD, Asthma, CHD, Heart failure, Hypertension and Diabetes – by cluster, Health Board and Wales

 Chronic liver disease including cirrhosis by age group

 All cause liver disease, aged under 75 years  Deprivation gap in lung cancer incidence by deprivation fifths

Priority 3: To improve  Mental well-being among adults Community & Personal  A sense of community Resilience, Mental  People feeling lonely Health and Wellbeing.  People who volunteer

Priority 4: To enable  Older people in good health people to age well and for those who  Older people free from limiting long need care to receive it term illness in their home or as  Life satisfaction among older people close to their home as possible (N.B interface  Hip fractures among older people with Social Services & Well-being Act)

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4 Recommendation

The Public Partnerships and Well-being Committee are asked to consider and provide feedback on:

The proposed set of indicators for the ABUHB priorities for the five Gwent Public Service Boards Well-being Plans

Assessment of the Impact of the Report: Financial The proposed recommendations can be Assessment carried out within existing roles and budgets; therefore there are no financial implications. Link to Three Year The Health Board has a statutory Plan responsibility to reflect its response to the Well-being of Future Generations Act requirements within the Three Year Plan. Risk Assessment Failure to comply with the Health Board requirements of the WBFGA may result in significant corporate risk for ABUHB.

Quality, Safety and The contents of this report do not impact on Patient Experience quality, safety and patient experience. Assessment Health and Care The requirements of the WBFGA potentially Standards link to all of the Health and Care Standards for Wales. Equality and Well-being Plans are subject to Equality Diversity Impact Impact Assessments. Assessment (including child impact assessment)

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APPENDIX 1

Priority Indicator title Framework/Source Definition of what will be Geographical level Frequency of measured reported at publication Priority 1: To provide Low birth weight Public Health The percentage of Wales, Welsh health Calendar years children and young Outcomes singleton live-born babies boards, Welsh local Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public people with the best Framework (PHOF) whose birth weight is authorities, USOAs, possible start in life below 2500g MSOAs, LSOAs

This is a national indicator Rural and urban areas in Wales

National deprivation fifths (WIMD) Children age 4-5 years PHOF Percentage of children in Wales, Welsh health Academic year who are underweight or reception year (aged 4-5) boards, Welsh local healthy weight who are underweight or authorities, USOAs, of healthy weight MSOAs

Rural and urban areas in Wales.

National deprivation fifths (WIMD). Tooth decay among 5 PHOF The average number of Wales, Welsh health 2014 - 2015 year olds decayed, missing or filled boards, Welsh local teeth (dmft) in children authorities *Survey conducted at aged 5 years different dates for Rural and urban areas different areas within

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in Wales this time frame

National deprivation fifths (WIMD) Vaccination rates at age 4 PHOF Percentage of children Wales, Welsh health Financial years who received the boards, Welsh local following scheduled authorities, USOAs, Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public vaccinations at age 4: MSOAs

 four in one pre- school booster (against diphtheria, tetanus, pertussis and polio)  Hib/men C booster (against Haemophilus influenza type b (Hib) disease and meningococcal C disease)  Two doses of MMR (Measles, Mumps and Rubella) Teenage pregnancies PHOF Teenage conception rate, Wales, Welsh health Calendar years females aged 15–17 boards, Welsh local years, per 1,000 females authorities, USOAs

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Priority 2: To achieve Adults who smoke PHOF The age-standardised Wales, Welsh health Health boards, local impact on preventable percentage of adults boards, Welsh local authorities: 2016/17 heart disease, stroke, (aged 16 or over) who authorities, USOAs. (financial years) diabetes, cancer, reported a smoking status respiratory and liver of 'daily smoker' or Rural and urban areas Trend: 2005/06-2007 – disease. 'occasional smoker'. in Wales. 2014-15* (two year rolling age-standardised Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public National deprivation percentages) fifths (WIMD). National characteristics: 2016/17 (financial years)

Upper Super Output Areas (USOAs): 2010 - 2015 (calendar years)

*Prior to 2007 WHS data were collected in financial years; from 2007 onwards WHS data were collected in calendar years. Adults who drink above PHOF The age-standardised Wales, Welsh health Health boards, local guidelines percentage of adults boards, Welsh local authorities: 2016/17 (aged 16 or over) who authorities, USOAs. (financial years) using reported drinking above the current definition the guidelines on the Rural and urban areas heaviest drinking day in in Wales. Trend: 2008-09 – 2014- the past week. 15* (two year rolling

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National deprivation age-standardised Current definition fifths (WIMD). percentages) using the (2016/17): Average former definition weekly consumption above 14 units National characteristics: Former definition (pre 2016/17 (financial 2016/17): Men drinking years) using the current Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public more than 4 units, women definition more than 3 units per day Upper Super Output Areas (USOAs): 2010 - 2015 (calendar years) using the former definition

*Prior to 2007 WHS data were collected in financial years; from 2007 onwards WHS data were collected in calendar years. Adults eating five fruit or PHOF The age-standardised Wales, Welsh health Health boards, local vegetable portions a day percentage of adults boards, Welsh local authorities: 2016/17 (aged 16 or over) who authorities, USOAs. (financial year) reported eating five or more portions of fruit or Rural and urban areas Trend: 2008-09 – 2014- vegetables the previous in Wales. 15 (two year rolling age- day. standardised National deprivation percentages, calendar fifths (WIMD). years)

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National characteristics: 2016/17 (financial year)

Upper Super Output Areas (USOAs): 2010 - 2015 (calendar years) Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public Adults meeting physical PHOF The age-standardised Wales, Welsh health Health boards, local activity guidelines percentage of adults boards, Welsh local authorities: 2016/17 (aged 16 or over) who authorities, USOAs (financial years) using reported that they met the current definition the physical activity Rural and urban areas guidelines in the previous in Wales. Trend: 2005/06-2007 – week. 2014-15* (two year National deprivation rolling age-standardised Current definition fifths (WIMD). percentages) using the (2016/17): 150 minutes or former definition more of moderate or vigorous physical activity National characteristics: in the previous week. 2016/17 (financial years) using the current definition

Upper Super Output Areas (USOAs): 2010 - 2015 (calendar years) using the former definition

*Prior to 2007 WHS

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data were collected in financial years; from 2007 onwards WHS data were collected in calendar years. Working age adults of PHOF The percentage of Wales, Welsh health Health boards, local healthy weight working age adults (aged boards, Welsh local authorities: 2016/17 Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public 16-64) who reported authorities, USOAs (financial years) having a healthy weight (Body Mass Index (BMI) Rural and urban areas Local authorities: 2014- between 18.5 and 25). in Wales 15 (calendar years)

National deprivation Trend: 2003/04- fifths (WIMD) 2004/05 – 2014-15* (two year rolling percentages)

National characteristics: 2016/17 (financial years)

Upper Super Output Areas (USOAs): 2010 - 2015 (calendar years)

*Prior to 2007 WHS data were collected in financial years; from 2007 onwards WHS data were collected in

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calendar years. Months of life lost due to NWIS An estimate of the Wales; health boards; Not due to be updated alcohol increase in life expectancy local authorities by PHO at birth which would be expected if all alcohol- NWIS now owning this related deaths among indicator. Frequency to males/females aged less be agreed Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public than 75 years were prevented. Recorded burden of AUDIT+ The total number, crude GP practices do not Not due to be updated disease and adjusted percentage and adjusted have a geographical by PHO recorded burden of percentage of patients definition. The disease. with selected chronic indicator includes Calendar year conditions. registrations to GP practices in Wales from The seven chronic residents of England conditions are: and Wales. Hypertension, Asthma, Diabetes, CHD, COPD, GP practice, GP cluster, Epilepsy and Heart health board and Wales Failure. Chronic liver disease Produced by Public Crude rate of mortality Wales health boards Rolling 3 year periods including cirrhosis by age Health Wales from chronic liver disease group Observatory, using and cirrhosis per 100,000. PHM & MYE (ONS). All persons, aged 20-74 and 75 and over All cause liver disease, Produced by Public European age- Wales health boards Rolling 3 year periods aged under 75 years Health Wales standardised rate of Observatory, using mortality from all cause

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PHM & MYE liver disease per 100,000. (ONS). All persons, aged under 75 years, by sex. Deprivation gap in lung WCISU Deprivation fifths (with National deprivation Rolling 4-year period cancer incidence by equal population in each fifths (WIMD) currently. deprivation fifths fifth) using the income Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public domain of the Welsh Intention is that WCISU Index of Multiple will provide deprivation Deprivation (WIMD). The analysis for all Wales on year of the index that we an annual basis use for analysis depends on the year of diagnosis as follows:

Diagnosis 1999-2004 WIMD 2005 Diagnosis 2005-2007 WIMD 2008 Diagnosis 2008-2010 WIMD 2011 Diagnosis 2011-2015 WIMD 2014 Priority 3: To improve Mental well-being among PHOF Average mental health Wales, Welsh health Financial year Community & Personal adults score in adults (aged 16 or boards, Welsh local Resilience, Mental over). authorities Health and Wellbeing. This is a national Rural and urban areas indicator. in Wales

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National deprivation fifths (WIMD) A sense of community PHOF Percentage of people Wales, Welsh health Financial year (aged 16 or over) agreeing boards, Welsh local with all three of the authorities following community cohesions questions of: Rural and urban areas Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public belonging to the area; in Wales that people from different backgrounds get on well National deprivation together; that people fifths (WIMD) treat each other with respect and consideration.

This is a national indicator.

People feeling lonely PHOF Percentage of people Wales, Welsh health Financial year (aged 16 or over) who feel boards, Welsh local lonely. authorities

This is a national Rural and urban areas indicator. in Wales

National deprivation fifths (WIMD) People who volunteer PHOF Percentage of people Wales, Welsh health Financial year (aged 16 or over) who boards, Welsh local volunteer (formally or authorities

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informally). Rural and urban areas This is a national in Wales indicator. National deprivation fifths (WIMD) Priority 4: To enable Older people in good PHOF The percentage of older Wales, Welsh health Health boards: 2016/17 Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public people to age well and health people who reported boards, Welsh local (financial year) for those who need being in good health. authorities care to receive it in Local authorities: 2014- their home or as close Rural and urban areas 2015 (calendar years) to their home as in Wales possible (N.B interface Trend: 2003/04- with Social Services & National deprivation 2004/05 – 2014-15* Well-being Act fifths (WIMD) (two year rolling percentages)

National characteristics: 2016/17 (financial year)

*Prior to 2007 WHS data were collected in financial years; from 2007 onwards WHS data were collected in calendar years. Older people free from PHOF The percentage of older Wales, Welsh health Health boards: 2016/17 limiting long term illness people who responded boards, Welsh local (financial year) that they are free from authorities limiting long term illness. Local authorities: 2014-

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Rural and urban areas 2015 (calendar years) in Wales National characteristics: National deprivation 2016/17 (financial year) fifths (WIMD) Life satisfaction among PHOF The percentage of Wales, Welsh health Financial year older people respondents aged 65 and boards, Welsh local Public Partnerships and Well Being Committee-09/11/17 Being Well and Partnerships Public over who rate their authorities satisfaction with their life as 7 out of 10 or higher. Rural and urban areas in Wales

National deprivation fifths (WIMD) Hip fractures amongst PHOF The European age- Wales, Welsh health Financial year 65+ year olds standardised rate per boards, Welsh local 100,000 of emergency authorities, USOAs, hospital admissions in MSOAs those aged 65 and over where the admitting Rural and urban areas episode has a primary in Wales diagnosis of hip fracture. National deprivation fifths (WIMD)

rows

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17 2.4 Tab 3.1 Social Services and Well Being Act Regional Partnership Board Minutes - 14th September 2017

3.1 Attachment 9a Gwent Regional Partnership Board – Thursday 7th September 2017 Committee Room 2/3, Floor 2, Civic Centre, Pontypool NP4 6YB

Present: Phil Robson (Chair), James Harris (Newport CC), Cllr Paul Cockeram (Newport CC), Jo Williams (Caerphilly CBC), Cllr Carl Cuss (Caerphilly CBC), Damien McCann (Blaenau Gwent CBC), Cllr John Mason (Blaenau Gwent CBC), Claire Marchant (Monmouthshire CC), Cllr Penny Jones (Monmouthshire CC), Emily Warren (ABUHB), Mel Laidler (ABUHB), Chris Hodson (Citizen’s Panel), Lorraine Morgan (Citizen’s Panel), Andrew Belcher (Provider Forum), Melanie Minty (Care Forum Wales / Provider Forum), Peter Kennedy (TVA), Stephen Brooks (TVA), Martin Featherstone (GAVO), Sarah Aitken (ABUHB)

Apologies: Judith Paget, Cllr Richard Clark, Keith Rutherford, Dave Street, Nick Wood, David Williams

Presenting: Richard Palmer (Data Unit Wales), Sam Crane (ABUHB), Richard Bowen (ABUHB), Bobby Bolt (ABUHB), Rob Holcombe (ABUHB), Gareth Jenkins (Caerphilly CBC), Barbara Cannito (ABUHB)

In attendance: Mark Saunders (Transformation Team, Claire Selmer (Administrator)

Apologies: 1. Introductions, and Apologies The Chair welcomed all to the meeting, and introductions were made and apologies noted.

2. Dewis and 111 i) Dewis Presentation – National Position Richard Palmer (RP) gave a presentation on Dewis, which is a national wellbeing directory for citizens and professionals. Dewis has been created over 3 years, and over 800 organisations have provided their information for the directory of services.

All resources on Dewis have a built in ‘shelf-life’ of 6 months, and if not updated when requested via email, the resource is then hidden. Resources are checked and approved by an editor before they appear on the site. This helps to keep the information ‘live’ and relevant.

The site is fully bilingual and entries can be added in either English or Welsh, and also viewed in both. In addition, Shaw Trust are doing an accessibility review to ensure that Dewis is user-friendly, and adjustments will be made to improve accessibility if required.

Dewis has an option to leave feedback on services, which is passed to the National Dewis Team; they are then aware of any issues, and can remove information from the site if there are concerns.

Dewis is now being used by frontline staff in Dyfed Powys Police on their mobile devices.

An app is being developed which doesn’t need a web connection, so people can access the directory easily whenever they need to.

RP noted the biggest challenge at the moment is getting information about grass roots services e.g. a local mobile hairdresser or local gardeners. The team are looking to Twitter and Facebook and trying to raise awareness / pick up information listed there.

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Peter Kennedy (PK) noted that sometimes the best person to ask could be a next door neighbour, and suggested it was a good idea to add this to the website. Cllr Paul Cockeram (PC) raised concern that not all are Facebook / Twitter users or even have access to the internet, and we need to be able to get information to them also. 3.1 Claire Marchant (CM) asked why there is 111 and DOS if we have Dewis. RP advised that Dewis and 111 sit alongside each other as a virtual directory. Increasingly projects are creating new directories and potentially duplicating what is already available on Dewis i.e. Public Health Team (N Wales); RP met with them and told them, and they now use Dewis to serve the information to their website. RP has also met with Age Cymru as they were creating an advocacy site, and as the directory element was already being done by Dewis, they are now linking this through.

Martin Featherstone (MF) noted that Infoengine has 50% coverage across CVCs. RP advised it doesn’t matter which site people access initially as the two are linked together; the main thing is that people find the information they need.

ii) 111 Regional Update Sam Crane (SC) and Richard Bowen (RB) gave an update on the national position and on the Gwent 111 programme. They aim to provide information and governance under one platform that the public can access. From a health perspective, there is already a lot of information on Dewis which they are now trying to tie into. They are also looking at NHS Direct information, and trying to link in with GP out-of-hours systems.

There is a challenge as to how people will access this range of services on bank holidays and on evenings / weekends. They are trying to look at a range of services, and to work with the public and a clinician to build a framework.

SC explained that it is important that people are seen in a timely manner and offered an appropriate service.

Following the introduction of 111 al calls will be routed through the new service. However, the Out-of-Hours service will still be operational as it is as present, behind 111.

111 will act as a filter at the front end. It will be important that we provide the correct level of information in order to direct people to the right place; for example, if an individual doesn’t need to be seen by the health service, they will be signposted to the correct service.

The Chair asked how they ensure engagement with the whole network of partners. He also noted it is good that people are being screened out of health, but queried where they are being screened to and whether these other services can cope. SC advised that they are linking with their communications and engagement group. Chair queried whether there is engagement with anyone from local government. CM advised she is on the national board, has not been to the local one, but she does receive the invites. SC noted that invites have been sent to each of the 5 x Directors. Chair advised he will make a recommendation to Leadership Group to follow up attendance, as directors have been invited but are not attending. PR

SC advised she is meeting with Peter Kennedy (PK) and Martin Featherstone (MF) to look at third sector links. They also need to look at how local authorities link up, as there are public and professional phone lines.

Melanie Minty (MM) asked if there is any learning regarding the interface with care homes. RB advised that within 111 there is a clinical hub which has a GP and pharmacy, there is also a dedicated number for care homes to contact, and they will receive a call back in 10 – 15 minutes. 2

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Actions:  Share the 111 work stream papers with all, for information. SC  Make a recommendation to Leadership Group regarding attendance at 3.1 national and local 111 meetings. PR

3. Integrated Commissioning and Pooled Fund (Part 9 of the Act) The Chair noted the context for this. The Regional Partnership Board is required to establish pooled budgets in relation to the provision of care homes for adults by April 2018 as stated in the Social Services and Wellbeing Act.

By way of background, Rob Holcombe (RH) gave a presentation on lessons learned from previous pooled fund arrangements in Gwent, notably through section 33 agreements.

RH explained the various types of pooled arrangements, varying from a l pooled budget with no risk sharing through to a pooled fund which with full risk and financial integration.

Bobby Bolt (BB) made a presentation outlining the statutory requirements and the work undertaken to date by a small working group. This included the review of the requirements to comply with the Act, although the view of the group is that this is not possible for April 2018. The group have identified the following options:

 Section 33 for all residential and nursing care homes for older people – Full implementation Year 1  As above with partner contributions equating to their costs as non-risk sharing – Year 1  Pooled fund for EMI Nursing Homes – Year 2  Regional Commissioning Unit

The group also identified the potential benefits and considered these from a service user, provider, statutory organisation and the market position. The options were then risk assessed against these benefits. The result of this is that the Group recommend that option 2 of the options is implemented. This would have a non risk sharing pooled budget in place for older people in care homes from April 2018. The Group also recommend that Officers work towards a collaborative approach to developing a Gwent wide fee setting strategy and work through the work programme needed to develop a single contract and integrated contract monitoring process.

CM stated that we are not strategically ready to implement pooled budgets and we need more time to develop strategic engagement around the service before we move to pool the money.

Lorraine Morgan (LM) made reference to the paper by Steve Vaughan from WLGA regarding the national market analysis; in future, based on current projections, at least another 1,000 care home places may be needed and questioned how will we deal with this? Chair noted that this is a valid question, but not one that can be answered at this stage.

MM noted the pooled budget requirement is causing problems across Wales, and in West Wales they took legal advice on what they should do, as local authorities were concerned this didn’t go along with statutory duties i.e. Section 151 Officers legal responsibilities. She also noted there may be complications with option 3 for proposals under RISCA, as they are looking to remove categories of care. Mark Saunders (MS) said this is something we need to be aware of.

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Cllr Carl Cuss (CC) advised that Dave Street had discussed the pooled fund requirements with the Caerphilly County Borough Council Cabinet. CC informed the meeting that the Cabinet were not in favour of the pooled budget, as at this stage they can’t see the benefit for residents of Caerphilly. They have expressed their concerns to the Minister and won’t pool until they have further information back. Chair therefore asked if Caerphilly 3.1 fundamentally disagree to this (pooled budgets), and there was definite agreement that they do. CC asked that if it does go ahead what sanctions there will be i.e. if there is an overspend, who funds the debt? RH advised it would depend how the pool was set up, but if we chose option 2 then for anything they spend or commission there would be a formal record, and by the year end whatever they spend they would need to put in.

Chair suggested we look at what we could bring to the market as one organisation, rather than 6 organisations; the fragility of the market is due to the number of organisations and the way we commission, if we look at the size of the budget we could commission modernised care provision / services and work together collectively. He noted that as a provider, it is difficult due to the number of people they are dealing with and lack of a strategic approach.

Cllr Penny Jones (PJ) suggested that if option 2 takes us to compliance, we need to move forward in more comfortable agreement, and then agree where we go from there. Chair advised we need to show the spirit of working together and then we will be in a better position to implement the legislation. He advised that the Ministerial letter won’t be the end of this, as there will be extended dialogue with all organisations until this is delivered.

Jo Williams (JW) noted this is seen positively by Welsh Government, and they have asked us to develop a model. Potentially there will be other letters, but we need more time and advice to make sure we do this properly.

CM noted the recommendations on paper and on the slides are slightly different; she advised we need to be clear which turn of phrase we are going with. She asked that we only progress after the first year once the position has been reviewed by the Partnership Board. James Harris (JH) agreed and noted that there needs to be a clear break in the plan, to make sure we do this. This was agreed by the Chair and that we need to continually evaluate the outcome as we progress with implementation.TT

A 3 year work programme is to be brought to the November meeting, along with a detailed plan of what we will do next year. This was agreed by those present. TT

The Chair accepted the challenges that the legislation presents, but also indicated that there are a range of positive outcomes that a pooled budget arrangement could deliver.

The Chair summarised by thanking the Core Group for the work they have completed to date. He noted the position with Caerphilly Local Authority and that, all other organisation agreed that we begin with implementing option 2 as described in the presentation. Chair stated that the officers need to speak with Torfaen Local Authority as they were unable to attend today. He will respond to the Minister reflecting this..

Actions:  3 year programme and detailed plan for next year to be brought to November meeting. TT  Plan to clearly state that position is reviewed by Partnership Board at each stage of implementation.  Discuss pooled budget options with Torfaen.  The Chair to write to the Minister reflecting the position as a result of the discussion at this meeting. TT

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CM and David Williams – ABUHB (DW) gave an overview of the work the Children’s Partnership is doing, and what they have achieved so far.

In the past year the Children & Families Partnership have developed an integrated assessment process; which was piloted in Caerphilly and is planned to roll out across 3.1 Gwent.

Complex Care funding for children is an issue as there is a level of complexity that needs to be worked through, and they are looking at a level of agreement for the region so there is a consistent way forward. On a long-term basis, it is thought a pooled budget would be beneficial.

DW advised they meet on a weekly basis to review referrals. They aim to support children with physical care and emotional health needs, and are now starting to look at autistic spectrum disorder. He noted they have developed an Attachment Trauma Service which is helping carers, professionals and children who have suffered early abuse.

Skills for Living enable children to develop independent living skills, and ICF monies are being spent on finding solutions. DW noted he would like the support of the Partnership Board, and would like to start delivery of integrated services for children in their care.

The C&F Partnership hasn’t had recurrent ICF funding, and are using the new allocation of £350,000 to start piloting and trialling ways of working and to make sure Skills for Living keeps going.

CM noted we are spending large sums of money on a small number of children and we need to achieve the right outcomes.

Andrew Belcher (AB) noted there was mention of involving the third sector, and queried how they are engaging with provider colleagues and housing partners, as there is a vast amount of learning there. DW advised this is being addressed under next steps. CM advised that they want to use the Provider Forum to engage with people who help with these services, and also to work with In One Place Board. They are also going to look at children’s services with HoCS, and at investment and a building.

Barbara Cannito (BC) advised she has been involved in 6 months of consultation for commissioning services for care leavers, and they have been looking at broader engagement with housing and providers. They plan to take actions forward that empower the sector to interface with them.

Martin Featherstone suggested that we need a maturity matrix to ascertain what good should look like in terms of timelines and risks; we need to ensure that progress is being made at a pace of change and we are satisfied with the service.

CM suggested it might be useful if she were to create an evaluative framework; setting out a range of actions needed to change the picture, and how we need the help of the Board to make these changes. CM

Cllr Paul Cockeram (PC) felt that we are moving in the right direction in terms of the C& F Partnership, but he did raise concern that it took 4 years to get there. He felt we need to move forward quickly as in some areas current models will be unsustainable in future years. Chair noted that it is a question of pace, and that these things do take time. David Williams – ABUHB (DW) noted that there is a strong sense that the foundation work has been done; there is a lot going on in the children’s sector for National Strategy, and they are bringing these strands in. Gareth Jenkins (GJ) agreed that, as a Head of Children’s Services, they are in the best position they have been, and he feels that the right priorities

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have been identified and plans are in place. However, he noted that we can’t do this with existing resources, and we need to free up other resources to fund them.

Emily Warren (EW) advised that funding is available under the Ministerial Advisory Group, and suggested we apply for some of the funding. 3.1

Rob Holcombe (RH) noted that from an insurance perspective it is a good idea to measure; to test the gains we can make with what is available, with evidence around the value/gain release funding.

Chair advised that Regional Partnership Board are to produce a matrix we can use at meetings. TT

Actions:  Create an evaluation framework which can be used across all Partnerships. CM  Produce a matrix to use at meetings. TT

5. WCCIS update There were no further updates this time; to be discussed at a future meeting.

6. Integrated Care Fund update At the start of this item JH read a prepared statement on behalf of the local authority cabinet members and members of Social Service;

“Despite the exchange of letters between the local authorities and the health board the issue related to the funding of tranche 3 remains unresolved. Specifically, the Health Board have not addressed the issue of apparent intended use of this funding outside of Welsh Government integrated care fund guidance. If this issue remains unresolved we (the Local Authority Executive Members and Directors of Social Services) will call an extraordinary meeting of the Regional Partnership Board in October to formally resolve the issue once officer meetings have taken place in the next couple of weeks.”

PC advised it appears that the health board have spent £1.2m without the agreement of the partnership or without any meeting to sanction this spend with officers of the Partnership Board. He further commented that this issue needed to be resolved urgently.

JH advised that the matter remains unresolved and that the use of the funding is inappropriate.

Chair advised that ICF money had been allocated by officers and to date none of the tranches had formally come to the Partnership Board for agreement.

The Chair stated that he is not in a position to answer for the health board but would urgently speak to Judith Paget, Chief Executive.

Chair stated that he was surprised that these issues had come directly to Regional Partnership Board and had not been settled by officers outside of the meeting. CM responded that the councils have not taken this action lightly and that officers have tried to resolve it; but despite many attempts, they have not been able to secure any time in the diary of senior health board officers.

Damien McCann (DM) noted that no decision had been taken on tranche 2 monies that finish at the end of September 2017. There are monies being spent supporting hospital discharge, and from a local authority perspective we need to give notice to staff and services if these are no longer going to be funded. Chair noted we can’t make decisions on the future of these projects as we don’t have the papers to discuss. ML noted this was 6

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because the item was not on the agenda of the August Leadership Group meeting. Chair agreed that the lateness in the day of notifying staff is an issue of concern.

Cllr Penny Jones (PJ) made the point that this issue is about proper scrutiny of the use of public money. 3.1

LM noted she raised a concern about a year ago that ICF monies could be used for the voluntary sector and housing, and isn’t happy at the way the monies are being utilised. She noted that there doesn’t seem to be enough evaluation here. CM advised this is a difficult position; tranche 1 and 2 have been evaluated but it hasn’t been possible to separate out tranche 3, as papers coming forward link tranche 2 and 3. She noted that a meeting is due to be held on 26th September 2017 to consider these.

Chris Hodson (CH) raised concern regarding the debate at today’s meeting. He felt that it was not acceptable that services and staff will be lost because we are unable to get the right people together in the same room; we should be working together closely. Chair agreed but understands that people have diary constraints they can’t necessarily reschedule.

JW suggested we need to separate out tranche 2 and 3. We can look at tranche 3 in September and have an email exchange for tranche 2. Decisions can then be made by December 2017.

Chair advised that it is not within the Partnership Board’s remit to make an operational decision without the proper documentation.

Mel Laidler (ML) has circulated an updated position paper to all, which looks at capital bids and governance. 6 schemes were submitted to Welsh Government and 5 are being supported, with a request for information regarding the feasibility of Crisis House; this is a young persons’ home and the feasibility study is being carried out by Monmouthshire CC; this will then to be considered by Leadership Group.

£1.4m has been agreed for the capital fund and ML advised they would like to see a strategic approach to spending. All expressed dismay at the spending period of 12 months, but Welsh Government are now looking at a 3 year strategy. RH is meeting with Welsh Government soon to discuss this.

MM referred to the new bid on feasibility, and queried the possible involvement of residential care homes. CM noted that Severn View is a specialist dementia unit and is residential but is built to nursing standard, so people don’t necessarily need to be transferred on. PC noted that Newport CC are going to be dementia only care homes, as they think this is where the need is.

The recommendations of the report were agreed.

Action:  Speak to Judith Paget and relevant people regarding ICF spend, and Leadership Group agreeing the way forward. PR

7. AOB No further items were discussed.

8. Minutes of last meeting (4th July 2017) and matters arising The minutes and actions were agreed to be an accurate reflection of the previous meeting.

9. FRS Priorities for Supporting HSS in Wales – Letter to Key Partners This document was for information and will be discussed further at a future meeting. 7

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10. All Wales People First and Self-Advocacy It was suggested that All Wales People First should be invited to a future meeting; this was agreed. 3.1 Action:  Invite All Wales People First to a meeting. TT

11. Area Plan This is for information only. The document considers how we will manage area plans in the region, and this has been agreed by Regional Leadership Group.

12. Next meeting Thursday 2nd November 2017 – 2pm Committee Room 1, Floor 2, Civic Centre, Pontypool NP4 6YB

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Public Partnerships and Wellbeing Committee Thursday 9th November 2017 Agenda Item: 4.1

Aneurin Bevan University Health Board 4.1

Minutes of the Public Partnerships and Wellbeing Committee held on Thursday 14th September 2017, in the Executive Meeting Room, Aneurin Bevan University Health Board

Present Phil Robson - Vice Chair Katija Dew - Independent Member (Third Sector) Shelley Bosson - Independent Member (Community) Lorraine Morgan - Chair of the Stakeholder Reference Group

In Attendance Sarah Aitken - Executive Director of Public Health Colleen Bright - Head of Partnership and Network Planning Nick Wood - Chief Operating Officer Will Beer - Principle Health Promotion Specialist Mererid Bowley - Consultant in Public Health Martin Woodford - Vice Chair, Welsh Ambulance Service Trust Debbie Waters - LMC Gareth Oelmann - LMC Tracey Morgan - General Manager, Primary Care and Community Services Alun Walters - Clinical Director, Primary Care and Community Services Eryl Powell - Consultant in Public Health Rachel Moore - Corporate Services Manager

Apologies Dianne Watkins - Independent Member (University) Joanne Smith - Independent Member (Community) Claire Marchant - Independent Member Sian Millar - Divisional Director Primary Care and Community Services Sam Crane - Head of Urgent Primary Care (OOHs)/111 Programme Emily Warren - Clinical Futures Programme Lead

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PPWB 1409/01 Welcome and Introductions

The Chair welcomed members to the meeting and introductions were made.

PPWB 1409/02 Declarations of Interest 4.1 There were no declarations of interest relating to items on the agenda.

PPWB 1409/03 Emerging Health Board Priorities for PSB Wellbeing Plans

The Committee received an update on the proposed ABUHB priorities for Public Service Board (PSB) Wellbeing Plans, including the key steps to be taken to meet them and how they fit with the ABUHB Well-being statement published in the ABUHB Integrated Medium Term Plan.

It was reported that the four proposed priorities were areas which required collective action to reduce health inequalities and improve the health of the people in Gwent. The Committee was advised of the proposed ABUHB system leadership role to address the six aspects of peoples’ lives that the evidence suggests were critical for tackling health inequalities.

It was noted that the report had been supported by the Executive Team and shared with some planning officers on PSB groups. The Committee discussed the Gwent PSBs Well-being plans time-line and highlighted that the plans were due to receive ABUHB Board approval on 21st March 2018. It was noted that the Committee dates for 2018 were yet to be confirmed. It was noted that ABUHB feedback would be required early in 2018 so an additional Committee meeting could be required. ACTION: Secretariat

The Committee discussed outcome measures and it was confirmed that each of the PSB plans would have clear outcomes aligned. The Committee emphasised the need for a clear flow of information between the Partnership Officers and Members on the Board.

The Committee was informed that the Primary Care and Community Services Division had designated Locality Managers in each borough who would be members of each of the PSBs. It was emphasised that these would need to

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link in with other areas/Divisions across the Health Board. It was added that the new Primary Care and Community Services structure would be in place from January 2018.

It was reported that meetings would take place with the Independent Member Leads and Officers to contribute to the agenda setting for the PSB meetings. It was noted 4.1 that there was also a Consultant in Public Health dedicated to each area.

The Committee discussed the role of the Executive Director as the locality structures develop. The Committee was informed of the new Head of Partnership and Planning role which would link more closely to PSBs and emerging structures. It was reported that Emily Warren would be taking up this role from 1st October 2017.

It was acknowledged that the Welsh Ambulance Service Trust (WAST) do not have the capacity to link in to each of the PSBs. However, it was suggested that they could either provide feedback via their ABUHB colleagues or could become a member of the Regional Partnership Board.

It was reported that the PSBs were starting to articulate their plans and would be holding workshops to develop these further. The Committee discussed the workforce plan and how this should be reflected within the PSB plans. It was emphasised that carers representation was required on the PSBs. It was acknowledged that a network between Independent Members and Public Health representatives was required. Sarah Aitken agreed to develop this further. ACTION: Sarah Aitken

PPWB 1409/04 Development of a Clinical Futures Level 1 Strategy

Sarah Aitken presented an overview and update on the work to develop a Clinical Futures Level 1 Strategy and provided assurance on the progress.

The Committee discussed the Clinical Futures Strategy diagram and noted that work was ongoing to identify the essential elements within each stage. Neighborhood Care Networks (NCNs) would be a second building block of the Level 1 strategy. NCNs were a model unique to Gwent and would provide information, assistance and advice through accessible, low level social intervention that was not

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constrained by process and eligibility. It was emphasised that the new level 1 framework would demonstrate ABUHBs ambition and intent to deliver a new approach to providing care closer to home, through new community based models.

The Committee discussed the proposals and provided 4.1 views on the layout of the diagram. It was recognised that a new message was required to emphasise care in the community. The Committee discussed the terminology and emphasised the need for improved engagement and communication. It was suggested that the Stakeholder Reference Group could form part of the engagement process. It was acknowledged that the NCN Newsletter was an excellent way to inform the public. The Committee noted the progress made to date and supported the proposals.

PPWB 1409/05 Impact of Changes to Communities First funding

Will Beer presented a progress update on the impact of changes to Communities first funding. It was reported that in February 2017 the Cabinet Secretary for Communities and Children announced the phasing out of the Communities First Programme over 2017/18. It was noted that to allow a transitional period, funding at 70% of existing levels was being provided until March 2018. It was added that following this, a legacy fund of £6m a year would be implemented in order to enable some of the most effective projects to continue.

It was reported that the Cabinet Secretary for Communities and Children set out his vision for a new approach to building resilient communities and tackling poverty, known as the ‘Three Es’; Employment, Empowerment and Early Years. The Committee was informed that a workshop between representatives from the Communities First lead delivery bodies in Gwent and the Health Board had been organised for 19th September, which would be facilitated by the Communities First Transition Team. Following the workshop an update would be provided to the Executive Team, followed by the Committee for consideration. ACTION: Secretariat

The Committee discussed the main issues and the impact on the Health Board, in particular the Living Well, Living Longer Programme.

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The Committee was informed that a meeting had been scheduled to look at outcomes to determine which programmes could continue with the legacy funding which would be signed off by the PSBs.

The Committee received an update on the discussions 4.1 taking place at each of the PSBs. It was emphasised that clear partnership discussions were required. It was recognised that some of the services could be covered through the PSB priorities.

It was acknowledged that the impact of changes to the Communities First funding needed to be raised as a risk to the Board.

PPWB 1409/06 Primary Care Resource Centre Developments

Tracey Morgan provided an update on the current position relating to Primary Care resource developments at Tredegar Health and Wellbeing Centre, Newport East Health and Wellbeing Centre and Bargoed Hall and Bryntirion Practices.

It was reported that Bryntirion Surgery and Bargoed Hall Family Health Centre informed the Health Board of their intentions to resign from their GMS contracts from 30 November 2017 and 30 September 2017 respectively. It was noted that the Vacant Practice Process considered all options for Bryntirion Surgery and agreed that the practice would be retained and would become an ‘anchor’ practice in the area. It was added that the practice had been advertised nationally and interested parties had been informed and patient letters were due to be issued.

The Committee discussed the position of Baroged Hall Family Health Centre. It was noted that the spread of patients at Bargoed Hall meant that the dispersal of patients was considered more appropriate. It was highlighted that a Managed Practice was considered but was not possible as the Primary Care Operational Support Team (PCOST) were already at capacity. It was reported that a positive meeting was held with practices in the area, where it was made clear that any allocation of patients would not be at the detriment to any other practice and could potentially make them more sustainable. It was added that the vast majority of patients from Bargoed Hall would also be allocated to a practice closer to home.

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It was confirmed that initial letters had already been sent to patients to advise that they would be informed of the allocated practice at the start of September. There would be an automatic enrolment process so patients would not need to attend the practice to register. 4.1 The Committee was advised that the LMC had received reassurance that if further funding was required for the new model for Bryntirion Surgery, this would be funded from another area and would not have an impact on the GMS budget.

The Committee received an update on the Tredegar and Newport developments including timeframes and services within the buildings. It was emphasised that technology was important to implementing integration. It was confirmed that Primary Care have a Gwent wide estates strategy which was reviewed annually to ensure it was aligned the current models.

It was agreed for the Committee to receive an update on the Tredegar Health and Well-Being Centre at the next Committee meeting. ACTION: Secretariat

The Committee discussed the Prestatyn Model which was still being developed and explained that a conference call had been scheduled with them to establish if a similar model would work in our area.

It was agreed for the following to be discussed at the next Committee meeting:

 New models in Prestatyn  Emerging model of Primary care for NHs Wales  Top 10 actions to release time to care  Sustainability model  Social model of Primary Care  Risk assessment and options available to the Health Board in the current situation ACTION: Secretariat

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PPWB 1409/07 Childhood Immunisation Uptake Rates

Mererid Bowley provided an update on the annual performance of the Health Board in delivering the childhood immunisation performance measures outlined in the National Outcomes and Performance Framework. 4.1 The Committee was informed that the Health Board achieved an annual uptake in 2016/17 of 96.6%, exceeding the Welsh Government target of 95% for the 5 in 1 vaccine by the age of 1, ranking third highest Health Board in Wales.

The Committee was advised that the Health Board achieved the WG target of 95% for children vaccinated with one dose of MMR by age 2 years, but was below the target for 2 doses of MMR in children aged five years (89.2%). It was noted that this was attributed to the expanding programme of childhood immunisation schedule impacting on the clinic time scheduled.

The Committee discussed the variation in uptake across ABUHB by local authority and NCN area including the potential causes, challenges and actions taken. It was reported there was regular monitoring of performance and an escalation process in place to understand he reasons for uptake below 95%. It was added that the Public Health Team had undertaken a literature review of effective interventions to increase immunisation rates in specific vulnerable groups or communities. It was recognised that the PSBs could be used to target these specific groups.

The Committee received an update on the latest position with the current measles outbreak in the Newport and Torfaen area. It was noted that a full report would be provided in due course which would be presented at a future Committee meeting. ACTION: Secretariat

It was reported that there was a delay in updating information on the child health computer system which had resulted in vaccination letters being sent to previous addresses. It was questioned whether practices could have editing rights to update personal information on the system which could potentially improve performance. Mererid Bowley agreed to establish if this could be actioned. Mererid also agreed to look into other methods of notifying patients including text messages.

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ACTION: Mererid Bowley

It was reported that NWIS were looking into developing an electronic system which would allow different systems to communicate together. It was noted that this was not expected until 2019 so another system would be piloted in the interim. 4.1

It was confirmed that there was no link between the uptake rate of the MMR vaccine and the measles outbreak. It was acknowledged that there had been an excellent response to the outbreak from primary care and the school nursing teams.

The Committee discussed the school aged immunisation Programme and agreed to receive a report on the performance at the next Committee meeting. ACTION: Secretariat/Mererid Bowley

The Committee thanked Mererid Bowley and the team for their leadership and hard work.

It was reported that the report was also presented at the last Executive Team meeting and an update will be provided in December with the next quarter’s data. It was agreed that the report should be shared with the Children’s Partnership Group. ACTION: Mererid Bowley

PPWB 1409/08 Carers Brief

Colleen Bright provided the Committee with an overview and update on the work of the multiagency Greater Gwent Carers Strategic Partnership.

It was reported that the Partnership was established in April 2016 in order to provide strategic oversight and leadership of the transition funding work programmes. It was noted that the first meeting took place on 11th September 2017.

It was emphasised that the identification of carers continued to be a challenge which emphasised the need for effective local strategies to identify carers and to refer them for help and support, where needed. It was noted that the 2016/17 and 2017/18 work programmes have sought to address the service and support gaps in addressing the needs to carers.

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The Committee was advised that the Annual Report was submitted to Welsh Government in June 2017, which set out the progress against each of the areas that would support carers under the SSWBA. It was reported that the Health Board was expecting to receive feedback from Welsh Government within the next month. 4.1

The Committee was informed that the work programmes planned and overseen by the Carers Strategic Partnership were currently funded by the 2017-18 Transition Funding budget and a business case for future investment would be presented to the Regional Partnership in November 2017. It was agreed for this to be raised with the Board.

It was reported that the carers assessments were still a priority for Local Authorities and would need to be a focus going forward. It was recognised that ICF needed to come through the Carers Group in the future to ensure clear mechanisms were in place.

The Committee was advised that the Welsh Government were in the process of refreshing the Carers Strategic Guidance, which would be going out for public consultation in September/October 2017 in readiness for implementation in April 2018.

The Committee thanked Colleen Bright for all her work over the years and wished her well in her retirement.

PPWB 1409/09 Risk Register

The Committee discussed the Risk Register and noted that the risks were consistent with the Committee’s work programme. There were a number of key risks highlighted including:

 Communities First - Phasing out of the programme from March 2018 and the impact on health improvement projects and programmes in deprived areas  Social Services and Well-being (Wales) Act – Dedicated planning lead  Consistent approach to PSBs  MMR2 uptake

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The Committee discussed the realignment of the Regional Partnership. It was agreed for Emily Warren to produce a paper to present at a future Committee meeting. ACTION: Emily Warren

It was agreed to provide an update on the Gwent Childhood Obesity Strategy at the next Committee 4.1 meeting. ACTION: Sarah Aitken/Jenny Evans

PPWB 1409/10 Public Service Board Minutes

The Committee received and noted the minutes from the Public Services Board meetings.

PPWB 1409/11 Minutes of the Meeting held on 8th June 2017

The minutes of the meeting held on 8th June 2017 were agreed as a true and accurate record of the meeting subject to an amendment raised by Lorraine Morgan regarding the Integrated Care Fund Process (0806/03). Lorraine Morgan agreed to send the amendment to Rachel Moore for inclusion in the minutes. ACTION: Lorraine Morgan/Secretariat

PPWB 1409/12 Action Sheet

The Committee considered the Action Sheet from the meeting held on the 8th June 2017 and noted that all actions had been completed.

PPWB 1409/13 Items for Board Consideration

 Impact of changes to the Communities First funding  Carers – transition funding  Clinical Futures – language and message

PPWB 1409/13 Date and Time of Next Meeting

It was confirmed that the next Public Partnerships and Wellbeing Committee meeting would be held on Thursday 9th November 2017 at 9:30am in the Executive Meeting Room, Headquarters, St Cadoc’s Hospital.

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Public Partnerships and Wellbeing Committee 14th September 2017 Agenda Item: 4.2

Public Partnerships and Wellbeing Committee

Action Log – 14th September 2017 Action Action Description Lead Progress 4.2 Referenc e PPWB Emerging Health Board Secretariat This action will be 1409/03 Priorities for PSB Wellbeing picked up under Plans agenda item 2.6 at It was noted that the Committee the meeting. dates for 2018 were yet to be confirmed. It was noted that ABUHB feedback would be required early 2018 so an additional Committee meeting could be required. It was acknowledged that a network Sarah Aitken between Independent Members and Public Health representatives was required. Sarah Aitken agreed to develop this further.

PPWB Impact of Changes to Secretariat/ Verbal update to be 1409/05 Communities First funding Will Beer provided at the It was noted that following the meeting. workshop an update would be provided to the Executive Team, followed by the Committee for consideration. PPWB Primary Care Resource Centre Secretariat/ Service Model plans 1409/06 Developments Tracey Morgan for the new It was agreed for the Committee to Tredegar Health receive an update on the Tredegar and Well-Being Health and Well-Being Centre at the Centre are next Committee meeting. currently being finalised. This will form the basis of the scoping document which is required to enter into discussion with the Welsh Government. It is anticipated that discussions will be held before the Christmas period. Following this, the full business case

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Public Partnerships and Wellbeing Committee 14th September 2017 Agenda Item: 4.2

will be completed, including architect plans and costs, which will be formally submitted for consideration 4.2 and funding approval.

It was agreed for the following to Secretariat Complete – item on be discussed at the next Committee the agenda meeting:

PPWB Childhood Immunisation Uptake Secretariat Complete – item 1409/07 Rates added to forward The Committee received an update work programme on the latest position with the current measles outbreak in the Newport and Torfaen area. It was noted that a full report would be provided in due course which would be presented at a future Committee meeting. It was questioned whether practices Mererid Practices are able could have editing rights to update Bowley to view the Child personal information on the system Health System to which could potentially improve see if addresses / performance. Mererid Bowley details are correct. agreed to establish if this could be They are also able actioned. Mererid also agreed to to email and phone look into other methods of notifying the Child Health patients including text messages. System Team to let them know of any changes to patient details. The current Child Health System is a stand alone system that does not communicate with

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Public Partnerships and Wellbeing Committee 14th September 2017 Agenda Item: 4.2

any other database. However, the incoming CYPRIS system, which is due to go live in ABUHB in 2018, is 4.2 linked to the Welsh Demographic System and therefore before appointments for childhood immunisation are sent to parents/guardians, there will be an automatic check that the Child Health System is using the most up to date address for the child.

The Committee discussed the Secretariat/ Complete – item school aged immunisation Mererid scheduled for Programme and agreed to receive a Bowley February 2018 report on the performance at the next Committee meeting. PPWB Risk Register Emily Warren Complete – item 1409/09 The Committee discussed the added to forward realignment of the Regional work programme Partnership. It was agreed for Emily Warren to produce a paper to present at a future Committee meeting. It was agreed to provide an update Sarah Aitken/ Complete – item on the Gwent Childhood Obesity Jenny Evans scheduled for Strategy at the next Committee February 2018 meeting. PPWB Minutes of the Meeting held on Lorraine Complete – 1409/11 8th June 2017 Morgan/Rachel amendment added Lorraine Morgan agreed to send the Moore to minutes amendment to Rachel Moore for inclusion in the minutes. All actions to be completed by the next meeting of the Committee unless otherwise stated

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