Primary care in Wales

Key recommendations

• Much more specialised care should be delivered in or close to the community. Physicians and specialist medical teams should expect to spend part of their time working in the community. 
• We need to move away from a workforce model in which we invest in either primary or secondary care, and towards more integrated team working – the hospital without walls – where specialists hold more of their clinics in the community, and GPs spend part of their time working with colleagues at the front door of the hospital.
• Primary care should no longer be synonymous with general practice – community healthcare must include a wide variety of different professions, specialties and therapies.
• People who live in nursing or residential care and often have multiple morbidities and complex medical needs should have access to enhanced primary care from GPs and to community services.
• A whole system approach across primary, community, secondary and social care is now required to deal with the impact of the growing pressure on unscheduled care.
• The RCP has led the call for Wales to lead the way by developing new integrated workforce models in rural communities.
• The role of the community physician should be developed. Wales should actively promote itself as a place to develop highly specialist skills in rural and community-based medicine.
• Medical education and training should equip doctors with the expertise to manage older patients with complex needs, including frailty and dementia, and to lead and coordinate the ‘whole care’ of patients in hospital and the community.
• Primary care should include more specialty clinics in the community which work with advanced nurse practitioners, specialist nurses, physician associates, pharmacists and paramedics, among others. 
• Health boards and GP clusters should embrace innovation in order to improve communication with patients and between healthcare professionals. Telemedicine needs to be further embedded into everyday practice.
• We have long advocated standardised electronic patient records, which can save clinician time and improve patient safety. We have called for the electronic communication of referrals, outpatient letters and discharge summaries between primary and secondary care, using structured documents taken from structured records.