Operationalising Prudent Healthcare in the GPOOH Setting: Facilitative Webinars

Dr Stephen Bassett

Dr Sara Hayes

Abertawe Bro Morgannwg University Health Board

Design, deliver and disseminate five 10-minute webinars. The first introduces the context and history of Prudent Healthcare (PHC), linking it to wider, contemporary resonant themes - Overdiagnosis, Slow Medicine, Too Much Medicine; the remaining four cover each of the principles, renamed according to the acronym SPEM (the Latin word for hope):

  • Standardisation: Reduce inappropriate variation using evidence based practices consistently and transparently.

  • Prioritisation: Care for those with the greatest health need first, making the most effective use of all skills and resources.

  • Empowerment: Achieve health and well-being with the public, patients and professionals as equal partners through co-production.

  • Minimalism: Do only what is needed, no more, no less; and do no harm.


The webinars will initially be available on a dedicated Abertawe Bro Morgannwg University (ABMU) intranet page, but the hope is subsequently to offer them at a national level.

These explain how and why PHC principles can be applied in the GP Out-Of-Hours (GPOOH) environment, grounding the abstract principles in operational reality. These lessons may also have a broader audience in primary care, and it is hoped will shortly be consolidated within ABMU’s GP clusters. The webinars will initially feature clinicians, but will be treated as living documents with the aim of incorporating patient experiences in the future.

This Project Supports Prudent Healthcare

This project helps to operationalise PHC principles by creating a memorable acronym by which to remember them (SPEM – Latin for ‘hope’) and anchoring this in four brief, visual webinars. The principles will be clarified and consolidated by linking them to a specific action set for the GPOOH context.

Anticipated Benefits

  • The first aim of this project is to raise awareness of the Prudent Healthcare principles by explaining them visually and providing a memorable structure by which to recall them. By using the Latin word spem, hope, as the mnemonic device it is intended to show that the PHC principles suggest a way forward in challenging times, and to inculcate a sense of ownership and empowerment to clinicians.

  • The second aim of the project is to ground the sometimes abstract PHC principles in operational reality.

  • Standardisation can be demonstrated in the implementation of catheter care pathways, 24/7 DVT pathways and End-of-Life pathways, all of which improve patient safety and experience and reduce procedural waste.

  • Prioritisation can be demonstrated by the application of the new Clinical Support Hub, part of the 111 Wales Pathfinder, which channels workflows much more efficiently than current arrangements and links patients with the right professional delivering the right process in the right place and with the right priority.

  • Empowerment can be demonstrated by supporting self-care, as exemplified by the 111 Pathfinder minor illness streaming processes, which are supported by pharmacists, also emphasising skillmix maximisation.

  • In combining the four principles, and expanding on their interlinkages, the webinars encourage clinicians to practice in resonance with the “new bargain between citizen and state” (Professor Mark Drakeford).

  • Minimalism can be illustrated by the Clinical Support Hub’s providing advice to paramedics on scene, enabling them to avoid unnecessary conveyance of patients and facilitating enhanced community care, particularly of Chronic, Complex, Frail and Failing, Elderly, Polymedicated, Polymorbid patients (CFEPs – “see-feps”). The assessment and treatment of UTIs, RTIs and SSTIs by pharmacists illustrates the principle of skillmix maximisation.

Part of Cohort Bevan Exemplar Projects 2015-16