Implementing Prudent Healthcare Principles in Wales; what is the role of Primary Care?

Problem

Prudent Healthcare was introduced by the Welsh Government in 2014, the aim is to change the culture of the NHS in Wales by engaging with the concept of Prudent Healthcare through four key principles. The aim of this study is to assess public, patient and clinician understanding, attitudes and experiences of Prudent Healthcare as well as their views about the perceived benefits, barriers and facilitators. Then, using this knowledge, to produce interventions which will help the public, patients and clinicians to adopt Prudent Healthcare within their daily lives and clinical practice.

Approach

This is an all Wales study which includes the views of diverse patient and public groups and clinicians from across different areas of Wales. Semi structured interviews (n=40) and focus groups (n=5) were conducted with patients and the public and semi structured interviews (n=40) and focus groups (n=5) with clinicians working in Primary, Secondary and Emergency/Out of Hours care in Wales. Data were analysed using framework analysis; the theoretical basis of analysis is based on behaviour change, specifically the COM-B model of behaviour change to develop a support intervention, expected to include communications/educational strategies.

Findings

At the core of Prudent Healthcare is the recognition of the important contribution that members of the public have in creating and sustaining their health and wellbeing through co production. In facilitating co production of health within the primary care setting, patients noted the importance of timely access to primary care and consistency of care with familiar health professionals. They also valued a holistic and multi-disciplinary approach with easy access to information and support services. However patients noted difficulty in accessing primary care, especially a specific health professional, also that appointment time was limited and support services were not always clearly signposted. While the majority of primary care clinicians interviewed were familiar with the term, Prudent Healthcare, there was less understanding of the implications. In terms of the implementation of Prudent Healthcare principles, the key issues that emerged that would facilitate implementation were the importance of multi-disciplinary working and knowledge of support services while barriers to implementation included pressures on staffing levels and the implication of these on providing services. Despite being a flagship policy, gaining support from GPs and patients there is still a long way to go before policy becomes embedded in how primary care clinicians deliver, and patients receive, Prudent Healthcare.

Consequences

Final results will be disseminated to the Welsh Government, the NHS and community stakeholders in Wales with the expectation that it will inform practice. Data from this study will inform the development of interventions designed to help members of the public and clinicians to understand and support the principles and adopt a Prudent Healthcare approach.