Transforming primary care: lessons from Wales Critical appraisal of primary care Pacesetter Programme published

New innovations in primary care services across Wales have proved positive, but greater impact could be achieved by supporting robust evaluation and public engagement, according to new research carried out by HSMC at the University of Birmingham. 

In 2017 Public Health Wales - on behalf of the Directors of Primary and Community (DPCC) - commissioned HSMC to carry out an external appraisal of the Pacesetter Programme: a three-year initiative of innovations in Welsh primary care services. 

The findings of the report, published today were shared at the International Conference on Integrated Care in Utrecht in May. 

Set up in 2015 with funding from the Welsh Government, the Pacesetter Programme sought to test and evaluate new approaches to improving population health through improving access to primary care provision.In total, 24 ‘pacesetter’ projects were run by health boards across Wales from 2015 to 2018, with 15 new pacesetters to be delivered in 2018/19. 

The appraisal by HSMC looked at the delivery of these projects in each Health Board and the overall contribution of the Pacesetter Programme to large scale primary care transformation. 

The aim was to provide learning for future primary care transformation programmes in Wales through comparing the experiences of the Pacesetter programme with research evidence and international best practice.This was carried out through qualitative interviews, surveys and workshops with project leads, Health Board representatives and national stakeholders across Wales. 

The study found that participants considered the testing of innovations that were relevant and responsive to the priorities for primary care to be a valuable experience, as well as an opportunity to share learning between Health Boards. Yet, there was recognition that the impacts and learning from the innovation projects could have been greater had there been better developed evaluation from the outset, more effective engagement with relevant stakeholders such as professional bodies, and more input by patients into design of new primary care services. 

Dr Jane Harrison, Lead GP Advisor for Public Health Wales’ Primary and Community Care Development and Innovation Hub, and Dr Robin Miller, from HSMC and the lead researcher for the Pacesetter evaluation, presented these findings at the IFIC conference in Utrecht, which was attended by delegates from 25 countries. 

Jane Harrison said:

“It was really good to have the opportunity to share the outcomes and experiences of the Pacesetter programme in Wales with researchers, clinicians and managers from around the world who are also engaged in innovative integrated health and social care programmes.

There was considerable interest in the progress being made in Wales, particularly in our new national primary care framework that takes a whole system approach to delivering care, working across traditional boundaries. 

The critical appraisal undertaken by HSMC provides us with an objective review that ensures we build on previous good practice and draw on the significant learning from front line teams who are driving transformational change in primary care across the NHS in Wales.” 

Robin Miller noted:

“As a result their positive impacts, many of these initiatives will continue beyond the initial three-year funding period. Equally importantly, the Pacesetter programme has generated enthusiasm and belief that innovation is possible in primary care, provided there is sufficient support and clarity of vision at local and national level. 

Going forward, building on the lessons of the Pacesetters regarding robust evaluation, public engagement and being clear on how projects can be funded in the long term will help ensure that future innovation programmes in Wales have a greater likelihood of success.” 

The findings of this research will be used to inform the future processof health and social transformation in Wales. An all-Wales learning event, co-ordinated by the Primary Care Hub and Birmingham University, will be held on 5 October 2018 to share this learning with senior Health Board teams, and other key stakeholders in Local Government, Third Sector and with representatives from Community Health Councils, and will provide an opportunity for further discussion of the research findings and their application. 

A series of online video resources and good practice guides is also currently under development. 

The Hub was established by Public Health Wales to coordinate support for health boards and clusters, at a national level, in the delivery of the national plan for primary and community care in Wales. 

Download the Critical Appraisal of the Pacesetter Programme report (PDF)