Powys. 2.1 Aggregate minerals are safeguarded under LDP Policy DM8 in accordance with the Aggregates Safeguarding Maps of Wales (published in 2012 by the British Geological Survey under contract to Welsh Government) and LDP Policy DM9 protects existing mineral workings from incompatible development.
Powys. Originally, six of the 17 Powys GP practices signed up to the CareWell Project. Of these six, one has withdrawn. The reason for the withdrawal is the perceived extra workload at practice level due to WP7. Intelligent feedback suggested that WP7 was not beneficial to Powys or even EU patients, and therefore the GP practice felt that the CareWell project required too much effort for the return. The particular issues were in relation to undertaking one-to-one interviews with the patients, which would be expensive in relation to GP time & opportunity cost. The full nature of WP7 did not become clear until the six GP practices had officially signed up. Of the five remaining GP Practices, one is also very concerned about the work load due to WP7. A local solution to ensure that this is kept as “light touch” as possible is being actively pursued in order to keep them as part of the CareWell project. Other contingency plans are being developed, but even if the project was reduced to four GP practices, 100 patients would still be secured for the project cohort. To date, all five practices have completed a Self Assessment Framework (see Annex 9.1) against the Ten Step Programme, to create a measurable baseline and to develop a local Practice Action Plan (see Annex 9.2 for an example). These Action Plans have been produced and shared with the individual CareWell GP practice facilitators. The Project Board is due to review the baseline positions across the GP practices in order to develop appropriate learning and development opportunities per step. It is already evident that areas of good practice are observable, and leading practitioners have been identified. The next steps are to exploit and share good practice around the pilot sites. D6.1 CareWell pilot sites operational
Powys. Each GP practice was visited by the member of the CareWell team who has been assigned to that practice. All aspects of the CareWell Project were explained in detail, but in particular recruitment and selection of the CareWell patients. At a Powys level, the Project Board drafted in the assistance of the Information team. Staff members were tasked with the creation of a Patient Pack and information leaflets that fitted in with the Information Governance rules and procedures. Following feedback at a WP7 forum with the local GPs, the Project Board agreed to employ a local specialist research company called ORS to help manage the recruitment, and undertake WP7 tasks in conjunction with the GP practices and the Information team. The GP practices were encouraged to write to 40 patients in order to get the cohort of 20 per practice. To enable flexibility, following the withdrawal of one of the practices, the D6.1 CareWell pilot sites operational available resource was reconfigured to allow the remaining GP practices the appropriate resource to recruit the full cohort as required by the CareWell Project. Each of the GP practices went about the task of recruitment in different forms. Step 1 of the 10 Step Programme is the aim of a Case Manager Management approach through MSDI. MSDI was procured and staff were trained. The GP practices, as a validation tool, also used the pen & paper approach, and used the search functions of their GP PAS systems. This approach proved successful, and the uptake was swift and positive. This process has provided enormous learning for the Health Board in relation to MSDI.
Powys. The Powys CareWell project can be split into three sections, with the 10 steps falling in the three categories. The first category is GP lead; there were certain training requirements, for example with the MDT approach. In order to allow this to happen, the appropriate District Nurses from the GP practices were trained on how to use Myrddin as a way of recording the relevant patient information, which then feeds into the MDT meetings (see Annex 9.4). The Information team were tasked with the creation of a manual and a training plan. With their able assistance, this task was completed before the rollout of the Project to allow the process to be tested and data validated. The second category included MHOL, MS Xxxx and WGGC. For this, the Project relied on external experts and trainers to provide the knowledge and training to allow these functions to integrate around the CareWell patients. The third category, including the Mobile Working work stream, has been more complex in its approach. Training for staff members is available through mandatory training. The specialist nurses have provided the cohort with training for individual’s kit as appropriate. This is individual to the patient, rather than a blanket approach, using the specialist nurses' knowledge and awareness of the patient’s local context. Other training opportunities in relation to progression across all 10 Steps will be exploited opportunistically. There are existing training programmes working to a longer timeline, which will be reviewed along the timeline. No specific training for carers has been envisaged or requested at this stage. However, by appropriately using Info Engine, training needs can be met by finding local courses. This need can also be discussed with the GP practices, who are themselves adding their local courses onto Info Engine to help create a larger database of knowledge.
Powys. Powys is supporting the CareWell pathways through ensuring the use of existing and new ICT through a Ten Step ICT Programme. Multiple existing functionalities are available within the Powys healthcare system; however these are not mandated, and therefore are not all currently in use. The Powys pilots focus is to ensure all existing functionalities are utilised around the patients, and through extension of those functionalities. As shown in the CareWell Integrated Care Pathway for Powys below, there are no major changes to the delivery of care. However, its introduction will support the patient wherever they may be on their journey, through improved communication and coordination between healthcare professionals, and empowering the patient in self management of their condition through the introduction of a ten step ICT programme. Stable patient out of hospital care Unstable patient out of hospital care In hospital care Hospital discharge preparation Public messaging Community Care Community pharmacy Direct access public Social care Direct access/CA Third sector Informal Carer Patient/ Patient rings family 999? health support Self-care District Nurse Community Care GP Yes Primary Care Social Care Care tranfer Community Care coordinator Discharge Advice to the Secondary Care team Social Care No Convey? Paramedic Hospital PURSH Xxxxx Xxxxxx Extend advice required? Yes Secondary Care Consultant Assessment + advice Yes Response Service Hospital nurse Ambulant or housebond (incl home care settings?) No Hospital Doctor Yes Practice Nurse No District Nurse Diagnostics (community Specialist Community Care Nurse Secondary Care Diagnostics
Powys. All ICT components within the Powys CareWell pilot are PtHB corporate technological tools, or are based on systems rolled out within wider programmes across NHS Wales. New items of equipment required for CareWell have been procured within the usual PtHB ICT procurement procedures that utilise national framework agreements for ICT that have been through rigorous procurement processes compliant with OJEU.
Powys. The Powys CareWell Project Office is operating as the Help Desk linking the Powys Project to European partners, stakeholders within Powys, pilot practices, and the patient cohort. The Help Desk is enhanced with the appointment of a named PtHB contact (Facilitator) for each pilot practice; within each practice there is also a named Project and Clinical lead. The Help Desk therefore has an extended structure into the pilot sites. This structure enables any questions and issues to be raised and dealt with at the appropriate level, whilst identifying any learning opportunities to be collated quickly, and shared effectively. The Project Office holds regular meetings with the CareWell Facilitators who raise any meetings / queries from their interaction with the pilot sites; these are then discussed as a group, and a response disseminated or flagged up to the Board if it is an issue of more strategic concern. The appointment of a lead Facilitator enables ownership of this process.
