Agenda item

Betsi Cadwaladr University Health Board

To provide a general update on Primary Care and Community Services. 


(a)       That the update on Primary Care and Community Services be noted; and


(b)       That Officers from BCUHB be thanked for their attendance and input 


The Chair welcomed Rob Smith, Area Director East, Lesley Singleton, Assistant Director of Strategy & Partnership Mental Health & Learning Disabilities, Jane Bryant, Area Nurse Director, and Dr. Gareth Bowdler, Area Medical Director East, to the meeting, 


The Chair invited the Officers to provide a general update on Primary Care and Community Services.   Jane Bryant gave an update on the range of nursing and community services available to support people who wished to be cared for at home.  She reported on the support provided to patients who were discharged from hospital to enable them to receive care and treatment at home and remain in their community.


Dr. Gareth Bowdler provided an update on Primary Care services and commented on the improved terms and conditions for employing GPs which it was expected would assist the offer of work for GPs in Flintshire to address recruitment shortage.  


The Chair thanked Officers for their update and invited Members to raise questions.


Councillor Rita Johnson referred to the closure of Flint hospital and the loss of beds and asked if Holywell Community Hospital had the capacity to meet demand.  Jane Bryant confirmed that occupancy levels were high, however, the Matron worked with Glan Clwyd Hospital and GP’s to ensure best access and use of community beds in Holywell Community Hospital .  The increased focus on treating patients at home in and out of hours was a key area to progress.


Councillor Hilary McGuill commented on the staffing of Minor Injury Units (MIUs).  She felt that in some cases staff did not have the right competencies/confidence to undertake treatments e.g. stitches or administering intravenous drips, which resulted in patients needing to visit Accident and Emergency departments in hospital.  Councillor McGuill suggested that nursing staff could rotate between main A&E departments and MIUs units to maintain skills.  Councillor McGuill also suggested that patients may be reluctant to be discharged from hospital because they may not have access to prompt diagnostic testing as they had as in-patients.


Dr. Gareth Bowdler agreed that there was a need to ensure nursing staff within MIU units had the right proficiencies and skills and this was an area of development which was a high priority.   Rob Smith referred to the review of urgent care provision currently taking place across Flintshire and Wrexham which was looking at improvements including closer links between GP’s, Accident & Emergency Departments and MIUs. Consideration was being given to integrating and rotating primary care and Accident & Emergency and MIU staff.  Dr. Bowdler acknowledged that there was room for improvement in discharge planning with one of the key concepts being that discharge planning should start as soon as a patient was admitted.  Regarding diagnostic testing, Dr. Bowdler advised that work was ongoing to facilitate diagnostic testing and to ensure that patients had appointments booked before being discharged where possible.


In response to a question from Councillor Ian Smith regarding replacement of fluorescent lighting with LED lighting at the MIU in Mold, Rob Smith agreed to make enquiries with the estate office and provide a response.


Councillor Kevin Hughes commented that he had experienced an 8 hour waiting time at Wrexham hospital Accident and Emergency Department and said that whilst he had received excellent service better communications at A&E Departments would alleviate frustration for patients and enable them to understand the reasons for delay. Councillor Hughes also commented on smoking outside the hospital entrance and asked what could be done to improve signage and promote education on the health risks.  Councillor Hughes congratulated staff at Wrexham hospital A&E department on the excellent work they do. 


Rob Smith said an 8 hour wait was not acceptable and referred to the national target of 4 hours which should be delivered in most cases.  He explained that BCUHB worked closely with hospitals to reduce the pressure on A&E departments and agreed to make further enquiries regarding the issue of communication and report back to the Committee.   He agreed with the comment that it would be helpful if patients were regularly updated if a long delay occurred.  Referring to the issue of smoking, Mr. Smith commented that this was an on-going problem and improvements seemed to have only a short term impact.  However, he would raise any specific concerns Members had around smoking outside the entrances to the Maelor Hospital with the hospital again. 


Councillor Marion Bateman said she had been advised that the X-Ray department at Mold Hospital only treated children over 5 years old and asked if BCUHB were looking to change the provision to include younger children.  Dr. Gareth Bowdler advised that the service available depended on the skill set of the individual member of staff on duty at the time rather than the patient’s age.


Referring to the recruitment of GPs the Chair asked if it was stipulated in their contract that they had to practice for a minimum of 2 years in Wales.  Dr. Gareth Bowdler advised that GPs on a training course received a golden ‘hello’ to enable them to set up practice in Wales for a couple of years following their training.


The Chair thanked Officers for their attendance and detailed answers to Members questions.




(a)       That the update on Primary Care and Community Services be noted; and


(b)       That Officers from BCUHB be thanked for their attendance and input 

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