Primary Care / Shared Care Case Studies

In arthritis patients, the longer inflammation continues, the greater the degree of functional impairment. The Directorate was unable to meet NICE Quality standards, in particular starting treatment within 6-8 weeks. Routine patients were waiting beyond 28 weeks. We underwent a three year transformational plan aimed at delivering a high quality integrated patient care. As a result, we have been able to achieve; • Job Planning: Up to 40% improvement in productivity (seeing new rheumatology... for more information
The Primary Care workforce in North Wales is under severe pressure with insufficient General Practitioners. This initiative explores the effectiveness of Advanced Physiotherapy Practitioners (APP) clinically assessing patients with musculoskeletal (MSK) problems as an alternative to the GP - thereby relieving GPs of this caseload. To date 38% of all referrals to the APP service are as first point of contact along with substantial cost savings. Admin
Historically, the only route available for GPs to refer non urgent patients to a cardiologist at Cardiff and Vale University Health Board was by referral to a consultant cardiologist outpatient clinic. Through a growing recognition that the status quo was no longer viable, a different model of care was needed, based on collaboration between primary (GP) and secondary (cardiologist) care. A hospital based electronic referral system (HeRS2) was developed, which facilitated e-Advice from a... for more information
Current Dermatology services are not sustainable with increasing demand and national shortage of Dermatologists. Referral rates from primary care continue to rise, widening the capacity gap and increasing waiting times. Teledermatology was suggested by the King’s Fund as a possible partial solution for this National problem. Following patient consultation, Aneurin Bevan University Health Board (ABUHB) Dermatology department worked closely with IT services and Medical Illustration to set up a... for more information
The paediatric outpatient department at Cardiff and Vale University Health Board faces unprecedented demand. Referrals have increased by nearly 40% in the last 8 years. Many of these children could be managed in primary. A group of paediatricians and GPs in Cardiff and Vale are working together to develop collaborative working practices. The team chose to use an integrated hub model for the new paediatric outpatient service. This involves a paediatrician delivering an outpatient clinic with a... for more information
A high volume of patients are referred to the oral surgery service in Cwm Taf University Health Board for dental extractions. The majority of these procedures are classified as minor oral surgery (MOS). Despite creating additional capacity in secondary care, the volume of patients has remained problematic with 2269 undergoing minor oral surgery in 2016/17. The aim of this improvement work was to; • Develop a service where appropriately skilled General Dental Practitioners undertake MOS in... for more information
Audiology at Abertawe Bro Morgannwg University Health Board (ABMUHB) is piloting the introduction of a Primary Care Audiology Service. It is consistent with the Welsh Government’s strategy to increase the number of services provided in the community rather than in hospitals. Most ear and hearing related symptoms can be managed by Audiologists rather than by GPs. Three primary care cluster networks have been selected as the pilot sites. The pilot stared in August 2016 and currently eight GP... for more information
Traditional diabetes services have relied on primary care referring to secondary care clinics for advice. This fragments care, incurs long delays due to waiting times to be seen results in duplication of work. Each of the 69 GP practices in the Cardiff and Vale area are allocated a named consultant who provides support to the diabetes service in primary care. Each consultant mentors 6-10 practices depending on list size. Consultants visit each practice twice a year for case notes review and... for more information
There was an increasing number of patients on the Ear Nose and Throat (ENT) waiting list with impacted wax who were unable to progress to audiological assessment for hearing aids. The aim of the improvement was to reduce ENT waiting list, engage practices in the correct referral criteria for removal of impacted wax and provide a cost effective and efficient service that improves the flow of patients through primary and secondary care. We also wanted to ensure that patients are accessing the... for more information
Irritable bowel syndrome (IBS) affects 15% of the UK population. Historically, patients have been given basic dietary advice in secondary care which for many is ineffective. Patients are often prescribed medication or referred for invasive procedures, including endoscopies and colonoscopies only to be given a diagnosis of IBS after many months or years of suffering. The low FODMAP diet is recommended by NICE as an effective treatment for IBS. Patients referred to the FODMAP-trained Dietitian... for more information