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GP Cluster Network Action Plan 2015-16

Llwchwr Cluster

Llwchwr Primary & Community Network Cluster Plan

Nov 2015

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Welcome to the Llwchwr Primary and Community Health network/cluster plan for 2015/16. The Llwchwr Health network based in Swansea and

following the closure of one practice in 2015 is made up of 5 general practices working together with partners from social services, the

voluntary sector, and the ABMU Health Board. Llwchwr covers the area of Pontarddulais, Gorseinon, Gowerton and Penclawdd and has a

registered population of approximately 46,800.

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Table to show the current list size of GP practices in Llwchwr and the change in since 2011

Practice

Practice List

Size 2011

Practice

List Size

2012

Practice

List Size

2013

Change

2012 to

2013(n=)

Change

2011 to

2013(n=)

Sept

2014

List Size

July

2015

W98008 PrincessStreet 8,212 8,183 8,224 41 12 8,587 8,644

W98012Gowerton 11,897 11,978 12,098 120 201 12,040 13,930*

W98013 Tal yBont 8,461 8,627 8,827 200 366 8,900 9,000

W98034 Ty’ rFelin 9,789 9,863 10,055 192 266 10,483 10.764

W98787PenyBryn 5,207 5,296 5,367 71 160 5,052 4,840

*Practice growth reflects the contract change to provide GMS services to patients formally registered at Penclawdd Medical Practice

Networks aim to work together in order to:

• Prevent ill health enabling people to keep themselves well and independent for as long as possible.

• Develop the range and quality of services that are provided in the community.

• Ensure services provided by a wide range of health and social care professionals in the community are better co-ordinated to local

needs.

• Improve communication and information sharing between different health, social care and voluntary sector professionals.

• Facilitate closer working between community based and hospital services, ensuring that patients receive a smooth and safe transition

from hospital services to community based services and vice versa.

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This is the second development plan that has been produced by the network and it is the aim to further develop the plan over the coming years.

The network will be regularly monitoring progress against the actions contained within the plan.

In order to support the development of the network cluster plan, information has been collated on a wide range of health needs within the

Llwchwr area.

The summary below highlights the key points. The health needs information has been taken into account when developing the priorities for this

plan.

Llwchwr Network has:

• 7 Dental Practices

• 11 Pharmacies

• 6 Nursing Homes

• High numbers of Elderly population

• High numbers of Asthma patients

• High numbers of Care Home patients

• Low student population

• Low ethnic minority patient numbers

• Low asylum seekers numbers

• The smallest percentage of patients in the ‘most deprived’ category of all Swansea networks

• The highest percentage of patients living in areas classified as rural

• The second highest percentage of patients on GP Practice CHD or CHD related chronic conditions register amongst Swansea

networks.

• The second lowest rate of people who smoke in Swansea networks and is significantly lower than the health board average.

There is a significant overlap of registered patients who live in adjacent geographical areas of Carmarthen

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Strategic Aim 1: To understand the needs of the population served by the Llwchwr Cluster Network

No Objective Action Key partners Forcompletionby: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 To continue to understandthe profile of LlwchwrCommunity Network and toreview the needs of thepopulation using availabledata

To create a LlwchwrCommunity profiledocument

• PHW• Primary and

Community Unit• Health Board

Informatics

Profilecompletebut will beannuallyreviewedandupdated

To ensure thatservices aredevelopedaccording to localneed

All practicesreviewed therevised data tocomplete theirpracticedevelopmentplans in July 2015and to inform thedevelopment ofthe cluster planfor 15/16

2 Respiratory Disease

• To continue toeducate patients onthe causes of asthmaand preventativemeasures

• Pulmonary Rehab

To signpost patients torelevant voluntaryorganisations.

Increase the number ofpatients accessing thePulmonary Rehabservice

To be aware of theinclusion/exclusioncriteria for patientreferrals

• CCM• GPs• 3rd Sector

CommenceJuly 15 andongoing

Less patientsdevelopingasthma

Higher number ofpatientsaccessing thePulmonary Rehabservice.

Funds wereidentified withinthe Network, butsupport no longerrequired assufficient fundingreceived from theHealth Board

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To explore any otheropportunities to supportPulmonary Rehabservice through use ofcluster funding

3 To provide CBT sessions forLlwchwr patients

To use funds to employprivate professionals toprovide CBT sessions

• GPs March 2016 Will improveaccess to CBT forLlwchwrpopulation ascurrent waiting listis >1 year

Will improve thequality ofmanagement ofdepression inprimary care

Professionalsidentified.Fundingapproved,protocol agreedand practicesable to refer

4 To support patients includingnewly diagnosed diabeticpatients (and those pre-diabetic patients) inundertaking lifestylechanges which will benefittheir health and wellbeing

To embed the WeightWatchers/Positive Stepsprogramme across theNetwork

To proactively review thenumber of patients beingreferred by the practiceto NERS/WeightWatchers

To increase numbers ofreferrals byreviewing/reducingreferral criteria to makeservice available to otherpatients who wouldbenefit

• GPs• Weight

Watchers• Positive Steps• PHW• Health Board

CommenceAugust2015 andOngoing

Better health forthose patientswith chronicdiseases

Improved lifestylechoices leading toa lessmedicalisedmodel of care

Practices arereferring patientsto WeightWatchers andpatients showingweight loss.Projectprogressing well

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5 To increase cervicalscreening uptake

To continue to raiseawareness of cervicalscreening programme:

Advertising via posters &leaflets provided bycervical screeningincluding GP practices,community pharmacistsand local authoritybuildings

To explore the potentialto contact patients bytelephone who have notparticipated in theprogramme. (Dependanton funding)

GP practicesCommunityPharmacistsLocal AuthoritybuildingsCervical ScreeningWales (forinformation)

March 2016 Early detection ofhealth risks

Current screeninglevels identifiedand areas of lowlevels targeted

6 To improve access to mentalhealth services

To increase mentalhealth nursing input

To provide in housecounselling services

To further develop theSCVS Mental Healthclinic within the LlwchwrNetwork and explorenew ways of working e.g.Development of MentalHealth focussed Noticeboards/InformationProvision within the GPPractices

SCVSHealth BoardGP practices

December2015

Improved, timelyaccess to mentalhealth services

Improved accessto counsellingservices forpatients whoneed Tier 0support either viapractice ornetwork level

Link in to MentalHealth officer inSCVS

Signpostingpatients to Tier 0servicesFurtherdiscussion to beundertaking atNetworks toprogress further

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To review and be awareof referral mechanismsto CAMHS

7 Reduce the number of fallswithin the network byproactively identifying andmanaging those patients atrisk of falls and furtherassociated complications.

Closer workingrelationship with ChronicCare Nurses

Identify patients at riskof falls

Pro-active care

To promote the use ofthe falls prevention guide

• GPs• Chronic Care

Nurses• District Nurses• CCM Team• SCVS

Ongoing Pro-activeidentification andmanagement ofpatients at risk offalls and furtherassociatedcomplications

A falls preventionguide has beenproduced anddistributed widelywithin Llwchwr.Further copies tobe producedtogether with asmaller 2 pageversion

8 Frail ElderlyTo consider all relevantactions that will assist inreducing the number ofhospital admissions for thisvulnerable group of patients;facilitating care at homewherever possible.

Develop closer workingrelationship with ChronicCare Nurses

To develop step up/stepdown beds at Gorseinon

Rapid access to MedicalHOT clinics and supportfor Community Careteams

• AGPU• CCM• GPs• 3rd Sector• Community

Connectors• Locality• LA

Ongoing Reduceadmissions tohospital

ThroughDementiaFriendly practicesprovideappropriatesupport andawareness

DementiaTrainingundertaken atPLTS session.

Community Hubsestablished

9 Develop the Local Area Co

ordinator pilot project :

ABMU to work with LACsto provide clear eligibilitycriteria for referringpatientsPractices to actively referpatients where suitable:

• LAC• Practices• Health Board

August2015 andongoing

Improved supportand signpostingfor residentswithin parts of theNetwork

Local Area Co-ordinator hasattended aNetwork meetingand made linkswith the practices

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(Unfortunately thisservice is only availableto some parts of theLlwchwr Network and notaccessible to allPractices and residents)

Local Area Co-ordinatorto attend clustermeetings

10 To increase the use of theHealthy City Directory withinthe network; signpostingpatients to the mostappropriate service

To promote the use ofthe Healthy directorywithin practices and topatients

• NHS direct• Health Board• SCVS• Voluntary

Sectororganisations

Ongoing Networkpopulation moreinformed onavailable healthand well beingservices

Further promotionof the use of theHealthy CityDirectory withinpractices and topatientsundertaken.Bannersproduced anddisplayed

11 To further develop the thirdsector support projectincreasing the use ofvoluntary sector services bythe Llwchwr Networkpopulation

Provide opportunities forthird sector organisationsto attend ProtectedLearning Time Sessionswith GPs and non clinicalstaff

Ensure that links aremade with voluntarysector organisationssupporting the agreednetwork priority areaswhere possible.

SCVS to map ThirdSector provision against

Led by Networkpracticessupported bySCVS

Led by Networkpracticessupported bySCVS

Led by Networkpractices

Ongoing

Ongoing

Dec 2015

Improved supportand access toservices for theLlwchwrNetwork

population

Up to date

information on

voluntary sector

services

displayed in GP

practices, e.g.

information

stands, notice

boards.

Develop theNetwork PLTSsessions todeliver training on

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network priorities.

Ensure that up to dateinformation on voluntarysector services isdisplayed in GPpractices, e.g.information stands,notice boards.

To extend voluntarysector presence withinGP practices in thenetwork by increasingthe number of practicesparticipating, HealthyPartnerships andexploring new ways ofworking jointly such aspre bookableappointments wherepossible

supported bySCVS

Led by Networkpracticessupported bySCVS

Led by Networkpracticessupported bySCVS

Ongoing

Ongoing

issues pertinentto practices inLlwchwr

SCVS colleagues

regular attend

Network Meetings

All practices are

taking part in the

Healthy

Partnership

project

12 Increase flu immunisationuptake

Lower performingpractices to work withPHW

PHWNetwork PracticesCommunityPharmacies

Mar 16 Protect patientsat risk and thewider population.

Good practice

discussed and

key areas for

progression

identified. Public

Health colleagues

attended Network

meeting to

promote flu jabs

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Strategic Aim 2: To ensure the sustainability of core GP services and access arrangements that meet thereasonable needs of local patients

No Objective Action Keypartners

Forcompletionby: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 Ongoing review ofcurrent demand forappointments andclinical capacity

Identify any potentialstreamlining systems andprocesses including theuse of anytoolkits/software available

Work with the PrimaryCare Foundation toassess access anddemand

• Practice• Primary

andCommunity Unit

Ongoing Services developed toreflect local need inline with capacity todeliver safe andeffective services

Individualpractice plansand feedbackfrom PCF inSeptember2015.

Cluster meetingundertaken withfeedback fromPCF

2 To investigate the

possibility of

developing the

Network as a

Federation

To look at the possibility of

Llwchwr Network

becoming a Federated

Network

Network

ABMU

March 16 Decisions taken bythe Network

Reviewing thework undertakenby a Network inBridgend. Eventto be arrangedin March 2016

3 To review workforcepressures and

To consider successionplanning arrangements at

• Practice Ongoing Seamless serviceprovision for patients

To explore thepossibility of

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develop localworkforcedevelopment plans

practices to be betterprepared for leavers

Increase peer support

Consider use of networkmonies to develop a GPresource for practices toaccess.

Consider developing skillmix across the network todeal with patient demandand GP pressures

employing aParamedicPractitioner.Informationreceived fromHywel Dda andcirculated tocolleagues withLlwchwr

4 To obtain patientand carer views onnetwork servicesand priorities

To continue to work withthe patient/carer groupdeveloped throughCommunity Voices

To consider areas of workthat the CommunityVoices group can supportpractices in sharingappropriate messages e.g.waste management

• SCVS Ongoing Responsive servicestaking into accountservice user and carerfeedback.

A communityevent has beenheld highlightingthe priorities ofthe Cluster Plan.Work Plan forthe CommunityVoices Groupdeveloped toinclude prioritieswithin the Plan

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Strategic Aim 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

No Objective Action Key partners For completionby: -

Outcome forpatients

Progresstodate/current position

RAGRating

1. To ensure that theneeds of patients andcarers are reflected inthe work of thenetworks

To continueimplementation ofthe patient andcarer participationgroup as part ofthe CommunityVoice Programme

To undertakeCarers trainingthrough PLTS

• GP Practices• Community

Nursing• Social Services• Third sector• Patient and Carer

ParticipationGroups

Established andongoing

Patients betterinformed ofpriories withinthe Network

CommunityVoiceProgrammeestablishedandprogressingwell withinLlwchwr

PLTSsession toraiseawarenessof CarersNeedsarrangedJanuary2016

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3 To improve awarenessof pathways on the GPportal

All clinicians andlocums to bemade aware ofpathways on GPPortal

Assess potentialto access GPportal frominternet ratherthan intranet

To receive alertswhen newtemplates areissued and toreceive feedbackfrom secondarycare colleagues

• GP Leads• PM’s

Established andOngoing

Ongoing

Ongoing

Improvedawareness andcommunicationwill result inmore effectivecommunicationwith secondarycare resulting inswifter and moreeffectivereferrals forpatients

GP Portalestablished.Continuedlinks withsecondarycarecolleagues

4 PMS Plus – RespiratoryPrescribing – to beconsidered on anetwork basis

To undertake arange ofprescribinginitiatives asrequired toimproverespiratoryprescribing

To make ScriptSwitch availablefor practicenurses

• GP’s• Practice Nurses• Medicines

Managementteam

Established andongoing

Improvement inpatient symptomcontrol

Investment inother serviceareas for patientbenefit.

OngoingmedicationswitchesbeingundertakenbyMedicinesManagement team

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Strategic Aim 4: To provide high quality, consistent care for patients presenting with urgent care needsand to support the continuous development of services to improve patient experience, coordination ofcare and the effectiveness of risk management

No Objective Action Key partners Forcompletion by: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 To reduce theinappropriate use of A&Eand GP Out of Ours

To improve patienteducation e.g. displayposters

Link in with alternativeservices e.g. AGPU

Decrease the number ofunscheduled careattendances

Signpost patients to ensureattendances are appropriateincluding e.g. ”choose well’’posters

• GP OOH• A&E• MIU• HB• Community

Voices

Ongoing Better educationon how to accessservicesappropriately tomeet their needs

Progression ofthe AGPUserviceincluding thenew OutreachserviceChoose WellCampaignmaterial eg:posters and zcards madeavailable topractices.(September2015).

2 Improve partnership withAmbulance Service

Improve patient education

Improve communicationbetween practices and theAmbulance service

• GPs• Welsh

AmbulanceService

Ongoing Betterunderstanding ofthe services thatare available forpatient transport

Discussionsongoing toimprove theservice.OperationsManager atWAST to beinvited to

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attend futureNetworkmeeting

3 To improve antimicrobialstewardship

To improve antimicrobialstewardship

To consider CRP testingduring the winter monthsTo undertake the antibioticaudit by December 2015

Medicinesmanagementteam

Ongoing

Quarterly

Monitoring

of trends

ReducedresistanceReduced C.DiffIncreasedknowledge andempowerment toself care

Discussed atall annualpracticeprescribingvisits. Clusterlevel data tohas beenshared atNetworkmeeting

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Strategic Aim 5: Improving the delivery of end of life care

No Objective Action Key Partners Forcompletionby: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 To review thenumber of deaths asper guidelines

Undertake reviewof number ofdeaths as perguidelines

GP LeadsSecondary CareColleaguesPMs

March 2016 andongoing.

Identification oftrends across theNetwork

NationalPathway workdiscussed andundertaken atDecemberClustermeeting

2 Use of and beddingin of Principles ofEnd of Life Care

To review thenumber of deathsas per guidelines

Practice levelregular palliativecare reviews andcompletion ofEOL template

• Practice• Community

Staff

March 2016 andongoing

More appropriateand amenable care

NationalPathway workdiscussed andundertaken atDecemberClustermeeting

3 Undertake regularaudit; sharing resultson a cluster networkbasis

Regular audits tobe undertakenand learningpoints to beprogressed

• Practice• Community

Staff

Ongoing NationalPathway workdiscussed andundertaken atDecemberClustermeeting

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Strategic Aim 6: Targeting the prevention and early detection of cancers

No Objective Action Key partners For completionby: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 SEA of all newlung, stomachand GI cancers

Regular reviewand audit oflung, stomachand GI cancers

GP Practices

Secondary Care

March 2016 andongoing

To diagnose cancersas early as possible totreat

Improved access todiagnostics andendoscopy in timelymanner

National Pathwaywork discussedand undertaken atDecember Clustermeeting

2 Undertakeregular audit;sharing resultson a clusternetwork basis

Regular auditsto beundertakenand learningpoints to beprogressed

GP Practices

Secondary Care

March 2016 andongoing

To identify any issuesand improve thediagnosis of cancers

National Pathwaywork discussedand undertaken atDecember Clustermeeting

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Strategic Aim 7: Minimising the risk of poly-pharmacy

No

Objective Action Keypartners

For completionby: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 Appointment ofClinical Pharmacist

Clinical Pharmacist to be

appointed and shared across

the Network focussing on

polypharmacy issues

particularly relating to

patients who have been

discharged from hospital or

are residing in a care home.

• GPs• Practice

nurses

Ongoing withinQOF 15/16

Shared CP wouldreduce medicineswastage, ensurecompliance withmedication andreduce the risk ofdrug contraindications topatients across thenetwork

All patients acrossthe LlwchwrNetwork will benefitfrom enhancedprovision ensuringpositive patientoutcomes

£36,000allocated toimplementthe clinicalpharmacistServiceacross thenetworkPharmacistAppointedand will startin January2016

2 Improvement/maint

enance against

target prescribing

indicators

Can consider and review

practice and network data for

antibiotics / statins /

hypnotics & anxiolytics and

discuss how improvements

can be made if required

GPs Ongoing within

PMS 15/16

Improvement in

prescribing quality

to improve health

outcomes

3 To provideaccredited trainingfor prescribingclerks

To provide accredited trainingfor prescribing clerks

Medicines

management

team

March 2016 Improved repeatprescribingsystems

Trainingpacks indevelopment

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4 To ensureappropriate use ofthe pharmacist andtechnicianresources to reducerisks frompolypharmacy

To ensure appropriate use ofthe pharmacist andtechnician resources toreduce risks frompolypharmacy

Medicines

management

team

Cluster

Pharmacist

available by

October 2015

Improved accessfor improvedpharmaceuticalcare

5 To engage in thePrescribingManagementScheme (PMS) andPMS+ respiratoryschemes (whichcontainpolypharmacyelements)

To engage in the PrescribingManagement Scheme (PMS)and PMS+ respiratoryschemes (which containpolypharmacy elements)

Medicines

management

team

PMS 15/16 – by

March 16

PMS +respiratory

– by

November 16

Improvedmedicinesmanagementincludingpolypharmacy

All practicesengaged andmakingprogress

6 To progresspolypharmacyissues identified inprevious clusternetwork plan

To progress polypharmacyissues identified in previouscluster network plan

Practice

teams

Ongoing Improvedprescribing andmechanisms forpolypharmacyreview

Ongoing

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Strategic Aim 8: Deliver consistent, effective systems of Clinical Governance

No Objective Action KeyPartners

Forcompletionby: -

Outcome forpatients

Progress todate/currentposition

RAG Rating

1 To continue toreview SignificantEvent Analysishighlighting themesand trends

SEAs reviewed byindividual practices on anongoing basisIncidents where there is adirect correlation tosecondary care are beingnotified to the HealthBoard

Practices to share SEAs atNetwork meeting to sharelearning

• GPPractices

• GPs• Practice

Nurses• Practice

Managers

March2016

Potential for changes toservices based onoutcomes of significantevents where there hasbeen positive/negativeaction

Practices topresent SEAs ateach of the 3Cluster meetingsbetween Oct 15and March 16Tal Y Bont,Princess Street,reported at Novmtg. Gowerton &Ty’r Felinpresented at Decmtg

2 To highlight thedowngrading ofcancer referrals

Practices to review allcancer referrals that havebeen downgraded thatwere subsequently foundto be cancer

GP Practices Ongoing Improvement tosystems to benefitfuture detection

Ongoingdiscussions.Issues need toraised with HealthBoard

3 Improve DischargeSummaries

To continue to raiseawareness of theproblems with practicesreceiving complete, timelydischarge summaries

• GPs• Locality

CD• Medical

Director

Ongoing Primary Care staff willbe better informed ofpatients condition andtreatment e.g.Medication

Issues raised withHealth Boardcolleagues.Furtherdiscussionscontinuing

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Strategic Aim 9: Other Locality issues

No Objective Action Key partners Forcompletionby: -

Outcome forpatients

Progress todate/currentposition

RAGRating

1 Access to CitizensAdvice Bureau withinGeneral Practice

CAB to provide anadvice serviceresource in the GPpractices within theNetwork, through theprovision of adviceworkers for 7 daysper week, six ofwhich to be providedas an outreach toNetworksThe pilot will also befully evaluatedfollowing the end ofthe pilot

• Locality• CAB• GP Practices

Funding untilMarch 2016.Full evaluationwill then beundertaken

Better support forpatients withwelfare /socialproblems thatneed dedicatedsupport andguidance.

Funding has beengiven to C.A.B tostart a pilot andthey will bepresent in aLlwchwr surgeryfor 1 ½ day eachweek to provideinformation andsupport topatients

2 To ensure thesustainability of primarycare services within theLlwchwr network givenconcerns in relation torecruitment problems &locum availability,together with high levelsof concern in respect ofseveral large housingdevelopments includedwithin the LDP

Notify LHB ofconcerns and flagspecific issuesrelating to individualpractices

Ensure that bothLHB and LA are keptinformed of issuesand concerns

Explore ways todevelop an inter-practice support

Primary andCommunity UnitLALMC

Ongoing work Sustain and aimto improve thelevel of servicesbeing providedwithin primarycare across theLlwchwr Clusternetwork

LHB aware ofnetwork andindividual practiceissues/workforceconcerns

Follow up meetingwith LA takenplace for PMs incluster

Correspondencesent to LA/LHB onbehalf of network

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network

Investigate how toinfluence locumcharges andavailability

Support training andrecruitment initiatives

Consider the nationalsustainabilityframework

Ongoing

Ongoing

Ongoing

notifying concernsFurther workongoing, includinginformationsharing

To consider thecontents of theWelshGovernmentstrategicdocument onPrimary CareWorkforce and tolink this to networksustainabilitypriorities.

3 Improving patient carewithin Llwchwr byworking with key partneragencies

Ensure cohesiveworking relationshipswith the Locality, EDcolleagues,secondary care,Local Authority,Pharmacy, thirdsector and toimprove patient carewithin Llwchwr

• SocialServices

• Communitynursing

• Third sector• Primary Care• Domiciliary

care• Independent

careproviders

Ongoing Integrated serviceprovisionprovidingseamless care forpatients

All key partnersattending Networkmeetings

4 INR service – ensuring

dosing and prescribing

are not separated

INR Enhanced

Service to be

commissioned

across practices

GP practices +/-

secondary care

services +/- HB

medicines

management

Ongoing Safer services

through not

separating roles

of monitoring and

prescribing – in

PBMA

(Programme

Budgeting &

Marginal Analysis)

exercise ongoing

within the Health

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Review of INR service to

ensure includes NOACs

OR

Consideration given

to mechanisms to not

separate INR

monitoring from

prescribing

e.g. use of

pharmacists or

medical scientists in

community doing

dosing & prescribing

OR secondary care

prescribing as they

do monitoring and

dosing.

teams line with MHRA Board, looking at

the AF pathway,

with a particular

focus on

Anticoagulation

Service Models.

Engagement

exercises

undertaken with

both GPs and

patients.

Currently

analysing existing

and suggested

service models

based on cost and

quality.

5 Ensure that the workingarrangements of centralhubs for communitynursing do not have adetrimental effect onworking relationships

Participate indiscussions toensure that a safeand effective servicemodel is developedand communicationwith GP Practices istransparent.

Encourage thedevelopment of aphlebotomy servicefor domiciliarypatients

• GPs• Health Board• Local

Authority

Ongoing Improved accessto services forpatients withchronic conditions

Hubs establishedand two waycommunicationbeing facilitatedthroughcommunitynetwork meetings,and further links inplace. Problemshave beenidentified and fedback to Hubs andHealth Board

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Strategic Aim 10: Other Locality issues

No Objective Action Keypartners

For completion by: - Outcome forpatients

Progress todate/current position

RAGRating

1