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Mansel Aylward presentation WSPCR 2010
1. 3rd November 2010
How the Public Health Wales Trust can help build the
integration of services, teaching and research.
Professor Sir Mansel Aylward CB
Chair Public Health Wales
Public Health Institute
2. Public Health Institute:
Conceptual Clarity
• Research, policy,
practice in an
iterative relationship Research Policy
• Creating a space for Knowledge
dialogue and Space
knowledge creation
• The art and science
of making a
Practice
difference
Public Health Institute
3. Conceptual Clarity
• Research and development
• Professional development
• Multi disciplinary/ Multi sectoral
• Focusing resources on the big
questions
• Wales in the world
Public Health Institute
4. What are we trying to achieve?
• A healthier, happier and fairer Wales
• Reduce premature mortality
• “Life to years” as well as “years to life”
• Reduce inequity/inequality
Through…
• Translating what we know works into practice
• Scanning the horizon- taking the long term
view
• Seeking “early wins”
Public Health Institute
5. Organisational Design
• A clear identity
• Professionally driven but
stakeholder focussed
• Networked model with a small
physical core
Public Health Institute
6. Moving Forward
• Early progress is possible, building on
existing functions and relationships
• Adopt an experimental pathfinder
approach- maternal and child health
• Grow the concept around core functions
and solid delivery
• Map existing networks and resources
• Engage potential partners in dialogue
Public Health Institute
7. Moving Forward
• Work within existing structures e.g.
NISHCR, Academic Health Sciences
Collaboration
• Explore funding possibilities-MRC,
ESRC, Lottery, Charities
Public Health Institute
8. Primary Care supporting
Public Health
• Promoting health of the population
– Patient empowerment; self management;
– Promoting public health messages
– Supporting Care in the community
• Improve safety and quality
– Safe systems
– Clinical effectiveness
– Encourage appropriate and more efficient use of
primary & secondary care services
• Primary care data
– Prevalence, activity, benchmarking
– Audit & Feedback
9. Implementing Strategy
Nationally coordinated, locally
delivered
National agendas need local expertise and
data
Most of the population have contact with
their General practice every year
10. Public Health Wales &
Primary Care
National organisation
• Primary Care Quality and Information
Service
• Primary Medical Care Advisory Team
• 1000 lives plus
• Evidence Based Sources
• Observatory
• Pharmaceutical Public Health
11. Welsh Backs
AIM
To minimise the financial, personal, and
psychosocial effects of mechanical low
back pain in Wales by promoting the
‘stay active’ message
12. Strategic Approach
• Consistent, clear and concise messages
• Identify appropriate resources
• An effective dissemination strategy
• Work with key stakeholders to deliver the
strategy
• Monitor, evaluate, feed back
14. %
10
20
30
40
50
60
70
80
90
100
0
Anglesey
Bridgend
Powys
Denbighshire
Vale of Glamorgan
Monmouth
Pembrokeshire
Swansea
Caerphilly
Blaenau Gwent
Wrexham
All Wales
Locality
Cardiff
Carmarthenshire
Ceredigion
Neath Port Talbot
Newport
RCT
Flintshire
Book (Nov 2007-Sept 2010)
Torfaen
Conwy
Merthyr Tydfil
Gwynedd
% of Welsh Practices Ordering The Back
15. WeMeReC Bulletin
Case studies sent to
• 2,470 GPs
• 2,900 pharmacists (first time participated)
Completed by
• 688 GPs (28%)
247 paper copy and 441 on line
• 103 pharmacists
Bulletin & copy of Back Book sent to
• 2,470 GPs / 2,900 pharmacists
16. Outcomes
Change in GP behaviour
– Significant increase in number of GPs giving the
stay active message
– Decrease in number of GPs advising rest
Change in population health
beliefs
– Staying active with back pain
– Not resting with back pain
17.
18. Clear Messages
• Work is generally good for people’s
health
• Early intervention is important to prevent
long term worklessness
• For people with back pain ‘staying active’
usually means staying in work
• Addressing the psychosocial issues
19. Appropriate Resources
Healthy Working Wales website
• E-learning
• Desk aids
• Downloadable leaflets / publications
• ‘Ask the expert’ e-mail advice
Health and Work Advice Line
The Back Book
National Education Programme
• RCGP half-day accredited training
20. Effective Dissemination
RCGP Events
200 GPs
CPD Sessions
(350 GPs) &
practice visits (400
GPs)
750 GPs
Online resources
(Deanery learning modules; WeMeReC
modules, HWW website)
600 GPs
Mailing of information to signpost to resources (such as
Back Book, signposting documents, WAMH in PC, online
resources, CPD session and RCGP events)
2000 GPs
21. Collaborative Working
• Welsh Assembly Government
• Cardiff University
• Postgraduate Deanery
• Welsh Medicines Resource Centre
• Royal College of General Practitioners
• Institute of Rural Health
• Health Boards
• Harvard University and other international Universities
• Department of Health (England) and Department for
Work and Pensions
22. Progress To Date
Back pain pathway agreed
• Focuses on ‘stay active’ message
• Includes advice on fitness to work
Back pain educational tool completed
• Produced and promoted by the Deanery
WeMeReC module on management of depression
Practice visits ongoing
CPD and RCGP accredited events arranged
23. Primary Care Quality &
Information Service (PCQIS)
Assists Health Boards, practice teams and
individual primary care practitioners to
improve the quality of the care that they
deliver by:
• Providing access to evidence-based quality
improvement guidance and tools
• Encouraging review, reflection and revision
24. PCQIS Supporting
Health Boards
NHS Wales Annual Operating
Framework 2010/11
• Improving patient care in the
community
• Chronic Conditions Management
• Primary Care Services
• 1000 lives Plus Programme
• Health Care Associated Infections
25. PCQIS & 1000 Lives Plus Programme
LHBs will be required
• To set appropriate local targets for the reduction of
harm
• To demonstrate participation and sign up to coding
of clinical data, process of data entry and sign up to
mini-collaborative
– Anticoagulation Monitoring
– Chronic Heart Failure (Wrexham project)
– Reducing Falls
– Infection Control / Hand Hygiene (support HCAI)
Toolkits completed or in progress to support these
26. Clinical Governance Practice
Self Assessment Tool
Objectives for the production of a web
based tool:
• To be used by practices to review progress made in
the development of CG processes within their
practices
• To provide assurance to HBs of the same
• Reference for inspecting bodies, such as HIW as
evidence that appropriate CG activity is occurring in
practices
• That can support revalidation
Primary Care Quality and
Informa3on Service
27. The Principles
• Standardised model across Wales
• Developed by practitioners and other
stakeholders
• Endorsed by GPC Wales & RCGP
• Designed to help practices review,
monitor & improve systems within their
practice
• Completed by practice team
Primary Care Quality and
Informa3on Service
28. Content
• Patient experience – environment, access
• Health & Safety – infection control, waste,
premises, security
• Risk management – clinical risk, business risk
• Clinical effectiveness – guidelines, audit
• Prescribing
• Relationships with external bodies
• Workforce – skills, recruitment, appraisal,
training
• Leadership
Primary Care Quality and
Informa3on Service
29. CGPSAT –
Supporting the GMC Deanery
Revalidation Project
• Pilot Project run in Wales 2008-9
• Three robust single systems fundamental to GMC
criteria
– Appraisal
– Managing performance concerns
– Clinical Governance
• Project tested the three systems in general practice
and engagement by LHBs – Wales is advancing
ahead in UK with national linked systems
Primary Care Quality and
Informa3on Service
30. CGPSAT –
Supporting the GMC Deanery
Revalidation Project
• If these systems not in place, practices and LHBs
would have to generate evidence on CG through
other routes
• CGPSAT useful, could be used by LHBs better.
Needs to be more robust
• Substantial changes made to CGPSAT in 2010-will
be released in November
Primary Care Quality and
Informa3on Service
31. New Work - Predicting/ Identifying
Areas of Risk & Good Practice:
Practice Profiling
• CGPSAT • Referrals
• QOF • Hospital data
• Audit • No of staff WTEs
• Questionnaires • List size per
• Complaints and notional WTE
incidents • Deprivation
• Immunisations • Income/Cost per
• Risk assessment patient
32. Integration
Service
• Coordinating function which facilitates delivery of
public health through primary care
Teaching
• Contributing to undergraduate and postgraduate
teaching
• Input into curriculum development
Research
• Evidence into practice
• Identify topics for research
