Accelerated Cluster Development toolkit

The Accelerated Cluster Development Programme is the Primary Care component of Place Based Care, delivered through Professional Collaboratives and Clusters.

Professional Collaboratives are the mechanisms by which, GMS practices, Dental practices, Community Pharmacies, Optometry practices, Community Nurses, Allied Health Professions, Social Services and others come together within their profession specific groups across a cluster footprint to consider how they respond to Regional Population Needs Assessments [RPNAs], consider the quality of their service offer and look at how they respond to national strategy for their respective profession, designing local solutions based upon their detailed knowledge and expertise.

“Working as a cluster ensures care is better co-ordinated to promote the wellbeing of individuals and communities.”

The definition that is now used for a Cluster is as follows:

“A cluster brings together all local services involved in health and care across a geographical area, typically serving a population between 25,000 and 100,000”.

Successful Cluster working enables health and care professionals to work across service boundaries and to influence the development of services for their patients. Cluster arrangements form the local footprint for the strategic aims of Regional Partnership Boards.

The Primary Care Model for Wales (PCMW) infographic which supports the vision in A Healthier Wales, contains 13 key components  required for transforming services.  These include effective collaboration at community level to assess population need to both plan and deliver seamless care and support to meet that assessed need.

Background

The Primary Care Model for Wales emerged from learning from the suite of 24 Pacesetter projects that commenced in 2015 and ran through to 2018.  Pacesetter funding was allocated to health boards to provide a systematic approach to test and evaluate new and innovative ways of working to achieve the aims of the 2015 Primary Care Fund namely achieving sustainability, improving access, and delivering more care in the community. Learning from the Pacesetter programme and the subsequent Critical Appraisal of the programme provided the foundations for the emerging model of Primary Care that, following wide stakeholder engagement, evolved into the agreed Primary Care Model for Wales in 2018.  An explainer video was produced in 2018 which outlines the journey taken to develop the Primary Care Model for Wales: Watch An Emerging Model for Primary & Community Care on Vimeo.

The local workforce is best placed to understand the needs and experience of local communities and to inform and influence wider public service plans. Clusters were established in 2010 to gather that intelligence and encourage the testing of new models of care to more effectively meet local needs. Whilst significant progress has been made, there is variation between clusters in relation to the maturity of collaborative working and the impact for patients and communities. Mainstreaming of successful projects and evidence of influence on wider strategic planning has been limited and a step change is now needed to realise the full potential of this approach.

In 2021 the Strategic Programme for Primary care introduced the Accelerated Cluster Development (ACD) Programme to ensure more rapid implementation of the PCMW and to address system barriers.

The Programme included the introduction of Professional Collaboratives (PCs) and Pan Cluster Planning Groups (PCPGs) to broaden and strengthen clinical engagement and to increase the influence from the community to Regional Partnership Board (Health Board and Local Authority) decisions (RPB).  A clearer separation of planning and delivery functions have been developed.

ACD is not about additional bureaucracy, it is about reinforcing and improving a suite of mechanisms and infrastructure that are already, in most cases, in place. It is fundamentally about a clear line of sight from the local front line health and care services through to the RPB in terms of understanding the needs of the local population and being able to translate such  knowledge into meaningful strategic priorities at an RPB / County and Cluster level.  In return this could translate into investment at a local level to deliver integrated, preventative models of care that support regional strategic priorities. This approach is designed to accelerate the wider implementation of successful projects.

Who is involved?  Where to find out more

The Accelerated Cluster Programme was developed following wide engagement with front line teams working in or seeking to develop engagement with Clusters to serve local communities.

An Expert Group was set up to advice on the deliverability of the products / proposals being generated by the ACD Programme, in effect “critical friends” drawn from across Wales. Products are also shared with Directors of Primary Care, Director of Planning and Directors of Finance to road test their content as well as colleagues in a number of Departments / Divisions in Welsh Government.

Vice Chairs play an important role within Health Boards with responsibility for primary care services.  There are also critical links with Regional Partnership Boards.

Useful resources

Read more about the Primary Care Model for Wales.

Read the ACD background briefing.

View the ACD roadmap infographic.

View the ACD What does this mean? poster.

View the ACD glossary of terms.

Professional Collaboratives (PCs) are networks of professionals, with shared expertise, working together to use their unique skills to assess the population needs of the population where they work.

PCs capture the knowledge and experience of local professionals to map service provision, identifying gaps and development needs to inform decision making and propose solutions. Working with professional peers and across service boundaries helps our workforce to deliver the standards of care to which they aspire and makes it easier for them to advocate for their community to achieve wider system improvements.

Overview

The Accelerated Cluster Development (ACD) programme is supporting the development of Professional Collaboratives for each of the independent contractor groups.  Similar work is being undertaken to engage the knowledge and expertise of the Nursing and AHP workforce and mental health care services in the community by identifying dedicated time to salaried roles.

Each professional group has a particular perspective on aspects of service provision. Professional Collaboratives provide a structure to support connection with peers to review the quality and safety of local services, share experience and good practice for the area of expertise and to advocate for service improvement.

The purpose of the Professional Collaboratives:-

• Promote inter and intra-professional dialogue and cooperation to improve patient care and experience; and
• To gather professional and user experience of the health and care system to inform priority setting and planning.

Aims include:-

• Improved population health and well being
• Increased value from the care and support provided
• Improved quality and safety of services
• Engaged and developed workforce

Professional Collaboratives are encouraged to propose the most effective solutions for the local context. This requires a dynamic approach to engage all relevant parties for a particular issue.

Clusters have demonstrated the importance of local knowledge and experience to inform service development. Regional Partnership Boards gain detailed local intelligence through these structures, from public, service user and professional feedback.

Roles and responsibilities 

All professionals should engage with their peers to maintain their knowledge of current systems and service improvement activity.  Teams should identify representatives to attend and support the local Professional Collaboratives. For Independent Contractors contractual incentives support this work.  Health Boards must ensure that salaried staff have dedicated time to participate.

Read about the role of the Professional Collaboratives.

Learn more about the Professional Collaborative and Cluster lead Roles. 

View the Cluster Lead role descriptor.

View the Professional Collaborative Lead role descriptor. 

GMS Professional Collaboratives:
Guidance for the GMS Contract 2021-2022

Pharmacy Professional Collaboratives:
A New Prescription: The future of community pharmacy in Wales

Optometry Professional Collaboratives:
Coming soon

General Dental Service Professional Collaboratives:
Coming soon

 Leadership/OD

A lead from each collaborative engages and works with other collaborative leads to form the core membership of the cluster, bringing a strong multi-disciplinary focus on to the needs of the local community.  Leaders support to develop skills and the Collaborative is supported by colleagues with the expertise (innovation, project management, finance, workforce planning etc) and time to develop and progress local priorities.

Watch the Collaborative and Cluster Lead tutorial video.

Building upon existing Cluster working with strengthened representation to develop a comprehensive understanding of needs and priorities. Clusters have a direct representation at County level Pan Cluster Planning Groups to inform and influence strategic plans and to propose effective local solutions.

Overview

Cluster working is well established across Wales and has delivered a wide range of innovative service improvements. However, the 2020/21 Cluster Survey and 2022/23 and 2024/24 Cluster Peer Review identified a series of barriers and informed recommendations for more effective Cluster working.

This retains the principle of a community orientated, needs based approach, using all local services and resources to achieve the greatest benefit for the Cluster population. Professionals work together to understand local needs and to develop solutions that are effective in the local context. There should be a dynamic problem-solving approach, bringing together the appropriate professionals to address specific issues. This work is supported by wider networks of clinical expertise and enabled by managerial skills including project management, finance, IT, public engagement, workforce and OD etc.

The Cluster Plan reflects the actions required at the most local footprint, but this should inform and influence wider organisational and partnership plans.

The membership includes representatives of each of the four independent contractor professions with nursing and allied health professional leadership and third sector services.

Roles and responsibilities 

Cluster meetings will be chaired by a Lead representative agreed by the group. The Lead is responsible for ensuring appropriate arrangements are in place for chairing of the meeting in their absence.

The core membership of the Cluster shall comprise of representation from all local services contributing to health and social care within the cluster area and shall include:

• Cluster Lead (Chair)
• General Practice Collaborative Lead
• Community Pharmacy Collaborative Lead
• Dental Collaborative Lead
• Optometry Collaborative Lead
• Community Nursing Collaborative Lead
• Allied Health Professional Collaborative Lead
• Third Sector representative
• Mental Health Services representative
• Medicines Management Representation
• Primary, Community & Therapies Services Senior Manager
• Cluster Development Manager

In attendance

• Head of Primary Care
• Finance
• Workforce and OD
• Cluster Support Manager
• Public Health Wales 

Other members may be included as required.

Patient representation will not form part of core membership, but Clusters will secure public  and development of local plans and services.  This may be through the establishment of Patient Engagement / Participation Forums but will be locally determined.

Governance

Clusters are structures to support and enable collaborative service planning and delivery. Cluster Annual Plans / Cluster Integrated Medium Term Plans should be developed to coordinate collaborative activities and to inform Pan Cluster Planning Group analysis, priorities and plans.

Participation should be managed through contractual performance reviews for independent contractors and as part of the performance reviews for salaried staff. Each improvement project should include an evaluation and articulate the financial governance arrangements.

Cluster budgets are determined by Welsh Government and delegated via Health Boards. The Health Board will delegate these budgets to the Clusters via the Pan Cluster Planning Groups. The Health Board and its partners may delegate additional resources to PCPGs and Clusters to achieve agreed outcomes.

All financial decisions must be made in line with agreed Standing Financial Instructions.  There will need to be an authorised signatory at the PCPG.

Overall cluster performance will be evaluated through cycles of Peer Review and Cluster Self Reflection.

Leadership/OD 

The Cluster membership will agree a lead as chair.

The lead will:-

• Bring together the wide range of cluster members to maintain a comprehensive and current assessment of the needs of the population served
• Coordinate agreement of local priorities and development of service improvement proposals
• Provide oversight of the work programme of the cluster to translate national strategic direction into action
• Support the development and delivery of effective governance and stewardship of cluster resources in line with Standing Financial Instructions using appropriate and prudent use of Public money
• Reflect upon and where necessary support changes to improve local cluster arrangements to ensure best outcomes for the public and to improve workforce experience

A range of development resources and opportunities is hosted by HEIW.

Access the Cluster meetings Terms of Reference template.

Read the ACD Supporting Governance  (model paper for health board use). This paper has been written in order to provide a framework for Health Boards to use, such that they are able to clearly articulate the relationship between the Health Board, newly forming Pan Cluster Planning Groups and Clusters. This will allow the Health Board in due course to be confident in exercising the functions of planning, commissioning and delegation / approval of resources.

This paper sets out the key governance principles, overarching legislation and suggested governance for consideration by health boards in developing and implementing the planning and delivery mechanisms described in the Accelerated Cluster Development programme.

Pan Cluster Planning Groups (PCPGs) are the mechanisms by which representatives of clusters come together at county population footprint to collaborate with representatives of health board and local authority, public health experts, planners and representatives of those services for which Professional Collaboratives are not appropriate e.g. services which should only be planned at county, health board/regional or even national level.

Purpose

The purpose of PCPGs is to deliver the aims of the Social Services & Well-being Act 2014 (the Act), The Wellbeing of Future Generations Act (2015) and A Healthier Wales. This builds upon current innovative practice and seeks to increase alignment and engagement between the Regional Partnership Board and Cluster arrangements bringing services together at a local level. PCPGs have been established as sub-groups of Health Boards and operate under the auspices of the Regional Partnership Board (RPB) giving a direct route for information sharing and decision making between frontline services and strategic leadership.

PCPGs agree a county population needs assessment and lead the development of integrated county level plans, making prudent use of all funding, workforce, and other resources and which address the health, care and wellbeing needs of the local population.

PCPG assessment of needs and plans must inform and be informed by regional level assessments of need (which are a statutory function of RPBs).  They should be viewed as a collective suite of interconnected needs assessments and plans. PCPGs will support the implementation of the joint partnership agenda, including delivery of change at a variety of levels, appropriate to need.

PCPGs bring together senior leaders from the NHS, Local Authority and key partners in the Third Sector to provide integrated system leadership which enables collaboration between partner organisations. PCPGs are informed by patient and public feedback, data based needs assessments and professional assessment of service pathway gaps, barriers and opportunities.

Over time, PCPGs may also commission services and develop agreements to support partnership working.  Strengthened local collaboration and a shared purpose is a priority for RPBs (Health Boards and Local Authorities) and driven through local organisational development strategies.  Local autonomy increase as systems mature.

Roles and responsibilities
Through the leadership and oversight of key work streams, the PCPG members will:

• Identify agreed priority areas for improvement which require strengthened joint working to achieve better outcomes within available resources;
• Develop and deliver a locality commissioning plan;
• Promote and “live” a culture which actively removes, barriers, blockages and silos within organisations to ensure seamless services for the local population;
• Engage key stakeholders in communities, with specific reference to minority and marginalised groups.
• Support joint work and where required gaining appropriate authorisation within their own organisations for such.
• Ensure that local government, NHS and third sector officers are able to work jointly within statutory and organisational governance arrangements that provide a framework of clear accountability:
• Exercise oversight of the way in which resources are used, including relevant grants from Welsh Government;
• Develop its capacity and capability for providing effective governance.
• Authorise joint work and where required gaining appropriate authorisation within their own organisations for such.

Membership

In addition, the meeting will be attended by wider stakeholders.

Commissioning should be undertaken on the basis of agreed principles:-

1. Understanding the needs of users and communities by undertaking effective and comprehensive engagement
2. Consulting potential and existing provider organisations, including those from the third sector, and local experts well in advance of commissioning new services, working with them to set priority outcomes for that service
3. Putting outcomes for users at the heart of the strategic planning process
4. Mapping the fullest possible range of providers with a view to understanding the contribution they could make to delivering those outcomes
5. Investing in the development of the provider base
6. Ensuring contracting processes are transparent and fair, facilitating the involvement of the broadest range of suppliers
7. Ensuring long term contracts and risk sharing, wherever appropriate, as ways of achieving efficiency and effectiveness; and
8. Seeking feedback from service users, communities and providers in order to review the effectiveness of the commissioning process in meeting local needs.

Funding and procurement

Read the ACD Primary Care Cluster Financial Guide 

Read the Welsh health circular number 25 – The financial framework. 

Conflict of interest

Read the ACD conflicts of interest guide

Leadership/OD

Access the Gwella HEIW Leadership Portal for Wales

Model terms of reference includes:

Governance:
Read the ACD Supporting Governance (model paper for health board use)

This paper has been written in order to provide a framework for Health Boards to use, such that they are able to clearly articulate the relationship between the Health Board, Pan Cluster Planning Groups and Clusters. This allows the Health Board to be confident in exercising the functions of planning, commissioning and delegation / approval of resources.

This paper sets out the key governance principles, overarching legislation and suggested governance for consideration by health boards in developing and implementing the planning and delivery mechanisms described in the Accelerated Cluster Development programme.

Decision making:

View the Pan Cluster Planning Group – Terms of Reference template

The membership of the PCPG, the Chair and Vice Chair will be reviewed annually.  The Chair will be agreed by the membership but it is expected that the Chair will rotate every two years.

The function, purpose, membership and governance of PCPG will be reviewed annually and the Terms of Reference altered accordingly.

There may be an identified need to undertake a review at other intervals in accordance with the implementation of health and social care national policy reforms and subsequent guidance.

View the ACD What good looks like infographic.

Moving forward, the option to form a Community Interest Company (CIC) or other legal entity across a cluster or pan cluster footprint to deliver services commissioned by the Pan Cluster Planning Group (PCPG) will be available for primary care providers.

This chapter sets out the key principles for the consideration and development of CICs, along with some templates you may wish to use.

How does this index work?
View this cluster delivery vehicles document for topic-specific content, which may include in-line synopses, direct signposting links, or links to further content on sub-pages.

1. Vision and Purpose
2. Why consider a corporate entity?
3. The choice of corporate entities
4. Social Enterprises and Community Interest Companies (CIC)
5. Factors to consider in deciding the choice of corporate entity
6. Reality checks
7. Pathway
8. Getting the model right: A perspective from Red Kite Community Interest Company
9. CIC Development Podcast – Red Kite CIC 

The Cluster Planning Support Portal (CPSP) indexes resources from across the system in Wales that may assist in producing and refreshing cluster/ pan-cluster planning group (PCPG) annual plans. It is structured to reflect the key elements of a planning cycle, providing an overview of considerations/ methodologies for assessment and response to local needs, linking to sources of further information, and supporting skill development. CPSP is aimed at cluster, PCPG, and professional collaborative members for awareness and oversight, and at primary care/ health board staff supporting them with integrated planning requirements.

Contents

The CPSP is divided into sections covering the following areas:

• Accessing planning guidance, support and training
• Developing plans: population needs and service use
• Developing plans: population health management
• Developing plans: evidencing what works
• Developing plans: deciding on priorities
• Implementing action
• Ensuring monitoring and evaluation
• Encouraging innovation

Access the Cluster Planning Support Portal (CPSP)

Monitoring refers to setting targets and milestones to measure progress and achievement and check whether the inputs are producing the planned outputs i.e. it determines whether implementation is proving consistent with design intent—implying we can tweak our approach during the monitoring period. Evaluation is not just about demonstrating eventual success; it also provides insights into why things don’t work (as learning from mistakes has equal value). Monitoring and evaluation are not about finding out about everything (which is intimidating), but are focused on the things that matter.

Monitoring and evaluation

The Ensuring monitoring and evaluation section of the Cluster Planning Support Portal is divided into sections covering the following areas:

• Project monitoring
• Project evaluation
• Logic models
• Evaluation plans
• PCMW/ ACD monitoring and evaluation plan
• Additional support resources

Access the Cluster Planning Support Portal  which includes a section on Ensuring monitoring and evaluation.

Cluster peer review 

Peer review allows those who best understand local systems and the current pressures to identify barriers and enablers and to share good practise. Peer review has benefits to clusters, Regional Partnership Boards (RPBs) and the Strategic Programme for Primary Care (SPPC) including highlighting structures and systems that are working effectively and identifying risks that remain unaddressed.

View the PCMW logic models.

Read the Cluster peer review 2023-24

This is the main supporting document for Peer Review 2023/24, for access to further resources used during the process – please contact [email protected] 

PCMW and ACD monitoring and evaluation plan

The Primary Care Model for Wales (PCMW) and Accelerated Cluster Development (ACD) Programme monitoring and evaluation plan sets out how these transformation ambitions will provide assurance of implementation progress, shared learning, and support joining up of local and regional plans. It describes the step-wise introduction of several supporting tools and products.

• • SPPC​​​ Monitoring and Evaluation Plan: Overview 
  • PCMW and ACD What why how who when infographic
  • ACD and PCMW Monitoring and Evaluation approach
  • ACD outcomes infographic 
  • Primary Care Model for Wales outcome infographic
  • Cluster Development Framework

Communicating and engaging with stakeholders to co-produce new or changing services is an important task for clusters. Communication is the successful conveying or sharing of ideas and feelings, therefore any information imparted or interactions with others are forms of communication. Engagement in this context is the process of encouraging people to be interested in the work of a cluster, and to include them in decision making.

Contents

The Engagement section of the ACD Toolkit is divided into sections covering the following areas:

• Why communication and engagement is important
• Cluster communication and engagement principles
• Cluster communication and engagement strategy
• Communication and engagement goals
• Stakeholders and audiences
• Communication and engagement channels and approaches
• Why engage with service users, carers and the public
• Communication and engagement with cluster staff
• Channels and approaches for health and care system engagement
• Channels and approaches for wider stakeholder communication and engagement
• Communication and engagement action plan and audit tool
• Dependencies and risks
• Continuous improvement in communication and engagement
• Cluster communication and engagement delivery plans – OASIS

This toolkit will remain a live resource we will continue to add information here which we hope will help and support you.

If you or your team have any templates or guides you feel would be a useful resource and you are happy for them to be shared on these pages please send them to: [email protected]

Resources relating to Primary and Community Workforce

Workforce Planning:

The Primary care cluster workforce planning – HEIW resource (launched July 2021) by HEIW provided resources and guidance on Primary Care Cluster workforce planning.

Locum Hub Wales was created in 2020, as part of the COVID19 response, as  tool to support workforce planning and booking shifts. It provided a central portal for GP Practices to advertise GP locum shifts and for GPs to locate and book GP locum shifts with ease. In July 2022 it merged with GPWales to become a single resource. GP Locums are not employed by GPWales; it is purely a mechanism to help GP Locums and Shifts find each other more effectively.

The Wales National Workforce Reporting System (WNWRS) portal provides a Web Portal for Primary Care Data, which is accessible to GP practice staff, Clusters and Health Boards of NHS Wales and other approved stakeholder organisations who have registered as users. Work continues on enhancing the people intelligence available through the portal to further support Primary Care workforce planning.

Workforce Development:

The A Guide for the Allied Professionals Workforce by the Strategic Programme for Primary Care (SPPC) provides AHP workforce guidance and a call for the whole health and social care system to implement these recommended organising principles to optimise utilisation of the AHP workforce in Primary and Community Care. This document is intended for clinicians, service managers and leaders, and to everyone else involved in the planning and delivery of clinical services.

The release of An NHS Wales Competence Framework for Nurses working in General Practice (October 2021) provided an outline of general practice nursing with role definitions and competencies outlined for each level of the career path in primary care general practice.

The Gwella Leadership Portal for NHS Wales, developed by HEIW provides a platform for networking, leadership resources and sharing good practice amongst peers.

The Fundamentals of Care Navigation package was developed as a result of the GMS Contract agreement for 2021-22 which included details for an Access Commitment to be introduced from 1 April 2022. The Access Commitment requires that care navigation be undertaken for all patients telephoning the practice and when their calls are answered, and where clinically appropriate, patients may be signposted to another appropriate service.

In collaboration with Practice Managers and clinical staff, HEIW led on the development of a structured eLearning package to support these GMS contract requirements.  The eLearning can be worked through on an individual basis or form the base for group/classroom learning sessions. It should take no longer than 2 hours to complete. The eLearning package comprises three knowledge and theory modules:

1. Fundamentals of Care Navigation
2. Skills for Care Navigation
3. Care Navigation in Action

A fourth module is included in the package as a downloadable workbook to guide users in the exploration of their local resources and community assets, and to aid effective signposting.   Although not a requirement of the eLearning, the workbook is provided to help increase care navigation confidence, skills, and performance.

HEIW also provides information additional Primary Care Training packages Practice Staff may find useful.  It is now available as a training package on the HEIW Y Ty Dysgu Learning Platform. 

Primary and Community Care Compendium of roles and models (PCCC)

A once for Wales digital platform for the sharing of innovative and unique models of primary and community care provision. It has been produced on behalf of the Strategic Programme for Primary Care (SPPC) in collaboration with Health Education and Improvement Wales (HEIW).

Collaborative and Cluster Lead Tutorial Videos

Professional Collaborative Video – Gwella HEIW Leadership Portal for Wales

Professional Collaborative Video – Gwella HEIW Leadership Portal for Wales

Professional and Collaborative Lead roles

Learn more about the Professional Collaborative and Cluster lead Roles. 

View the Cluster Lead role descriptor.

View the Professional Collaborative Lead role descriptor. 

This toolkit will remain a live resource we will continue to add information here which we hope will help and support you.

If you or your team have any templates or guides you feel would be a useful resource and you are happy for them to be shared on these pages please send them to: [email protected]

ACD – Master slide deck

ACD digital and design leaflets

PCMW and ACD What why how who when infographic

ACD and PCMW Monitoring and Evaluation approach

ACD outcomes infographic 

Primary Care Model for Wales outcome infographic

ACD Monitoring and Evaluation / Peer Review

SPPC​​​ Monitoring and Evaluation Plan: Overview 

Read the ACD Supporting Governance (model paper for health board use)

ACD transition year Peer Review process 

Logic Model
View the PCMW logic models.

ACD: What Good Looks Like Principles

ACD: What Good Looks Like Principles

Standard Alternative Provider Medical Services (Wales) Contract

GP Services – NHS Wales Shared Services Partnership

Alternative Provider Medical Services (APMS) FAQs