Service transformation in primary and community-based care

ROUND TABLE DISCUSSION, 24 JUNE 2025

Background

Access to GP practices is one of the issues older people raise most frequently with the Older People’s Commissioner for Wales.

The previous Commissioner, Heléna Herklots, published a report, Access to GP Practices: older people’s experiences in March 2024, and GP Practices in Wales: A Guide for Older People in July 2024. The Guide has proven to be one of the Commissioner’s most requested resources. In July 2024, the Commissioner chaired a roundtable event, hosted and supported by the Royal College of General Practitioners, to examine how her recommendations could be taken forward, and published a progress update report shortly afterwards.

Rhian Bowen-Davies took up post as Commissioner in September 2024 and chaired a second round table event in November. Since then, there have been significant developments, including:

Between December 2024 and February 2025, as part of the process for developing her own priorities and workplan, the new Commissioner invited older people to share their experiences and help shape the action she takes during her own term. The survey results reflected those of the original Access to GP Practices report. Older people are still struggling to access the type of appointment they need within their GP practice, they feel that waiting times for appointments are too long, methods in which to gain appointments are not meeting the needs of the older population, there continues to be a lack of continuity of care and some older people feel discriminated against on the basis of their age and that they are not being listened to. Positive experiences were received as part of the consultation. However, overall access to GP’s remains one of the most consistent themes raised by older people with the Commissioner during her engagement visits and via her Advice and Assistance service;
In May 2025, the Commissioner launched her new strategic plan and work programme. There will be a continued focus on older people’s access to primary care services in her work programme. In particular, the Commissioner has also seen an increase in concerns from older people on oral health and dental care and will be taking forward a separate piece of work on dentistry;
Jeremy Miles, Cabinet Secretary for Health and Social Care, has announced a proposed GP-led service transformation in primary and community-based care. Whilst welcoming this development, the Commissioner is concerned that the learning from the Access to GP Practices work is not lost, that the barriers to older people’s access are removed and that the new GP-led services do not perpetuate existing problems;
The Commissioner is conscious of the increasing focus of the Welsh Government and NHS Wales on supporting older people and people living with frailty, preventing older people from deconditioning in hospital, and the risks and opportunities of expanding digital healthcare systems.

Round table

The Commissioner wanted to create an opportunity to bring key elements of Welsh Government, NHS Wales and professional leadership together to discuss how these various developments can be harnessed to inform service transformation in communities a coherent and integrated way that ensures older people are part of service redesign, get maximum benefit from primary and community-based healthcare in the future and are not excluded by the system in the future.

The Commissioner therefore held a third-round table discussion on service transformation in primary and community-based care on 24 June 2025. The purpose of the meeting was to:

carry forward the learning from previous work on older people’s access to GP practices into the GP-led work on service transformation in primary and community-based care recently announced by the Cabinet Secretary for Health and Social Care;
expand the discussion to include frailty and deconditioning in older people;
discuss how digital technology and innovation can drive and support person-centred service transformation;
agree next steps.

Discussion

In a wide-ranging and informative session, participants discussed:

continuing challenges older people experience in accessing GP services, including long waiting times for appointments, digital exclusion, and the need for significant investment in primary and community-based care;
the need to future-proof the healthcare workforce in the light of of an ageing population and the importance of multidisciplinary teams of health and social care professionals working together in the community to provide comprehensive care for older people;
consistent implementation of the Primary Care Model for Wales across all health boards to manage complex care needs closer to home;
the challenges and opportunities of primary care clusters, including funding issues, time and headspace for strategic thinking, and the need for better integration with social care services to provide holistic care;
the latest General Medical Services contract agreement, including: a new requirement for GP practices to identify people at moderate or severe risk of frailty, using a recognised tool for people over 65; a quality improvement project on continuity of care in GP practices over a three to five-year period, and a review of access standards which will consider equity of access and reasonable adjustments for certain groups of people;
the impact of service transformation on older people and the need to capture and measure people’s experiences;
the importance of continuity of care: for patient satisfaction, as patients build trust with their clinicians, do not need to repeatedly explain their medical history and are less likely to be referred to hospitals or visit emergency departments; and for improved clinician satisfaction, reducing the risk of mistakes and building stronger relationships with their patients which can lead to better retention of healthcare professionals;
wrap-around support for older people who are slowing up, at risk of losing their independence or already dependent on others, including the importance of prevention, proactive integrated health and social care services, and the development of a digital segmentation and stratification tool which will help clinicians keep older people healthy and independent for as long as possible;
preventing older people from losing functions such as thinking ability, continence, strength and mobility – known as deconditioning – in hospital, including the development of a tool to measure deconditioning which will in due course be able to be used by anyone anywhere, including older people themselves in their own homes. Discussion emphasised the importance of recognising deconditioning early and intervening to prevent harm;
digital transformation in primary care, including the development of AI tools, an integrated care record, and the importance of user-centred design to improve service delivery and patient experience. Discussion highlighted the role of digital champions and user research panels in ensuring that services meet the needs of all users.

Next Steps

Participants agreed to share further information and opportunities to continue to build networks and dialogue going forward, to ensure a coherent approach to service transformation in primary and community-based care which will provide the best possible service for older people.

The Commissioner stated she would publish a progress report summarising the discussion.

The Commissioner is conscious that the vast majority of patient contacts take place in primary and community care. She values key stakeholders’ continuing participation and the perspective they bring to this important discussion and hopes it will continue.