Cluster Development Plans - 2015-16

• Ensure the sustainability of core services with appropriate risk management and actions to address local needs, including improved access to services.
• Strengthen GP multi-disciplinary team working and inform local workforce strategies.
• Further develop horizontal integration to support sustainable general practice and new models of care led by local teams (for example, developments may include cross referral for clinical care; federations of GP practices; shared administrative support; full practice mergers)
• Further develop local needs assessment working closely with colleagues in public health and developing a shared understanding of priorities across health and social care services
• Develop more effective collaborative working with community services (including nursing, local authority and third sector) to improve the coordination and quality of care and to optimise the availability of professional skills. Prioritise signposting to the most appropriate professional or self care.
• Further develop 2014/15 cluster network actions where appropriate.

Key objectives

• To update the practice needs assessment and prioritise actions in the Practice Development Plan, including proposals at cluster network and local health board (LHB) levels.
• Improve systems of clinical governance through action to address priority areas in the CGSAT, such as vulnerable adults, adults with a learning disability and safeguarding children.
• Develop the maturity of cluster networks to drive improvement of local services through clear prioritised actions to inform the direction of resources and management of delegated budgets and community staff where appropriate.
• Deliver quality improvement through continuing work in the three national priority areas:

1. Prevention and early diagnosis of cancer.
2. End of life care.
3. Minimising the harms of polypharmacy.

Strategic Aims:

1. To understand the needs of the population served by the Cluster Network
2. To ensure the sustainability of core GP services and access arrangements that meet the reasonable needs of local patients
3. Planned Care- to ensure that patients needs are met through prudent care pathways, facilitating rapid, accurate diagnosis and management and minimising waste and harms
4. To provide high quality, consistent care for patients presenting with urgent care needs and to support the continuous development of services to improve patient experience, coordination of care and the effectiveness of risk management
5. Improving the delivery of end of life care
6. Targeting the prevention and early detection of cancers
7. Minimising the risk of poly-pharmacy
8. Deliver consistent, effective systems of Clinical Governance
9. Other Locality issues