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Background: Welsh Government policy is to deliver integrated care services closer to citizens’ homes. However, how frontline services could deliver improved services focussed on populations or patient groups has not been detailed or evaluated. From 2018, the capital region of Cardiff successfully implemented a local CommunityHealthPathways programme, publishing 500 evidence-based clinical pathways systematically developed by joint working between primary, secondary and mental health care clinicians, providing just-in-time guidance appropriate to the local context of the citizen. Welsh Government has consequently commissioned a national CommunityHealthPathways programme, with strong system-wide governance and leadership to support standardised delivery of integrated care. The programme exploits a ‘Once for Wales’ approach to maximise value of investment through a shared national pathway development process, governance and outcome measures. Approach: Using learning from Cardiff, Welsh Government/NHS Wales have developed a national approach to development of integrated pathways, supporting care of citizens in the community and describing interventions and standards for delivery, and also for subsequent localisation that reflect local population or workforce needs. Essential programme components include Leadership from a national programme management team and National Clinical Networks, which can include patient/citizen voices and third sector, as well as local leadership from primary and secondary care and clinical editors in local Health Boards, with patient/carer support encouraged. Results: Since the ‘Once for Wales’ national programme was launched on 1/3/2023, national clinical editors have published over 230 CommunityHealthPathways ready for localisation in each Health Board in Wales, with 229 more in development. With 1,426 digital pages of referral guidance and thresholds, there have been over 700,000 pathway page views, across 5 digital platforms. Health Boards and GP clusters have used the localised pathways to help review outpatient waiting lists, and have supported patients’ own GPs to review whether patients need to continue waiting for consultant review or whether an integrated service could provide an alternative. Typically 40% of patients can be removed from waiting lists safely through this mechanism, and up to 72%. Health Boards have also recruited Interface GPs who work supportively with specialists to lead clinical working groups and develop pathways, new services, and even triage referrals from GP peers, based on locally agreed CommunityHealthPathways. In Cardiff, these roles have helped reduced need for consultant outpatient assessments by around 10% typically. Use of CommunityHealthPathways to enforce changes in clinical practice, has been successfully used in conjunction with Remote Guidance services for GPs to discuss with specialists those cases that do not fit a CommunityHealthPathway. As a result MRIs of lumbar spine have reduced by 72% and ultrasound scans of shoulders have reduced by 92% in Cardiff. Savings of £400,000 have been reported with an associated growth in referrals to physiotherapy. Implications: This programme demonstrates how the national policy of development of clinical pathways, localised to reflect population and workforce need, has been implemented at speed, at scale, with strong governance and leadership through adapted learning across a nation. Patient/Carer/Third sector voice is apparent at national and local development stages.

The HealthPathways Community, a global network of local health systems, is collaborating to get evidence and policy into practice at scale and improve the quality and experience of care for patients and clinicians. Based on a shared vision and values, the HealthPathways Community has developed a scalable approach to local care pathway development, to enable learning health systems. Each pathway is developed collaboratively by local clinicians, using a facilitated workgroup model to build relationships and reach agreement about local care processes. HealthPathways optimises patient flows and makes best use of the health workforce by supporting clinicians to practice at the top of their scope, reducing unwarranted variation in care. The HealthPathways Community has grown to include over 60 local health systems across New Zealand, Australia, the UK, and Canada, collectively responsible for the care of over 30 million people. Clinicians viewed HealthPathways guidance over 16 million times in the last 12 months. During the COVID-19 pandemic HealthPathways was used to rapidly get evidence and policy into practice across New Zealand and Australia, with pathway updates occurring daily. The community is collating examples improved quality and efficiency of care including reduction in low value diagnostics, improved prioritisation of outpatient consultations, and reduced acute demand. These have been translated into cost-savings of $9.76 per $1 invested in pathways. Recently the community has been developing methodologies for addressing equity issues in pathways. Key lessons from the development of the HealthPathways Community include the importance of shared vision and values, partnership and collaboration, effective local stakeholder engagement, agile development processes, and robust clinical governance. We aim to continue to grow the HealthPathways Community, strengthening the network to benefit all members. We are exploring the application of AI large language models to both the development and user experience of pathways.

GPs play a pivotal role in palliative care, navigating complex physical, psychosocial and existential needs. Although ideally positioned to provide holistic, continuous care, they face significant challenges. This article outlines core principles, clarifies the roles of specialist services and offers practical guidance on referral.

Background Precision medicine tailors an individual’s healthcare to their genetics, environment and behaviour. This has been driven by rapid advances in genomics, where an individual’s entire genetic code can now be sequenced. General practitioners (GPs) are increasingly involved in genomics throughout the lifespan, including performing prenatal screening during pregnancy, requesting reproductive genetic carrier screening and arranging genetic referrals for cancer and other conditions. Patients are relying on their GPs to appropriately counsel, test, refer and manage genetic conditions, and provide genomic healthcare. Objective This article provides an overview of the GP’s expanding role in genomic medicine, some tools to assist GPs to navigate this landscape, and barriers to genomic uptake. Discussion GPs are integral to supporting patients and families in the genomics and precision medicine era. Resources specifically aimed at, and codesigned with, GPs are required to enable broader and equitable access for the benefit of all Australians. Now more than ever, general practitioners (GPs) have a key role in genomic medicine. With their existing expertise in risk screening and family- and patient-centered care, GPs are already arranging genetic testing of chromosomes and single genes and arranging referrals for genomic testing (incorporating an individual’s entire genetic makeup). Genomic medicine is increasingly relevant for GPs caring for their patients across their lifespans, covering pregnancy-related screening, cancer, cardiology, neurology and many other areas of medicine.1–4 Recent rapid advances have led to cheaper, more accurate and faster genomic testing and screening options and the emergence of advanced therapies for conditions such as cancer, neuromuscular disease and genetic blindness.5 This has paved the way for precision medicine – defined as a tailored healthcare approach incorporating relevant genetic, environmental and behavioural information into a person’s care. This offers a major new frontier in medicine and much promise for disease prevention and cure.6 For example, genomic-based targeted treatments for cancer; tailored medication prescribing guided by pharmacogenomics;7 polygenic scores supporting stratification of the population by disease risk for common conditions such as heart disease and cancer;8 and population-based genetic screening,9 reducing unnecessary interventions and improving healthcare at scale.5,10 Precision medicine is listed as a future-focused healthcare priority by the Commonwealth in ‘Australia’s Primary Health Care 10 Year Plan 2022–2032’.11 The PRECISE (Practitioner Readiness, Education, Capabilities with Implementation Science Evaluation) genomics project is currently embarking on improving genomic resources for Australian GPs to support their provision of genetic healthcare. This paper will provide an overview of: - GPs’ expanding role in clinical genomics - tools and resources that can support GPs to navigate genomics - barriers to GP uptake of genomics.

A controlled, before-after intervention study of the uptake of evidence-based non-drug interventions (HANDI) by General Practitioners provided via the already established HealthPathways platform.

Abstract Background Women with a history of hypertensive disorders of pregnancy are at an increased risk of cardiovascular disease. Although clinical practice guidelines for management of hypertensive disorders of pregnancy recommend involvement of a general practitioner for ongoing cardiovascular disease preventative care, there are no intervention strategies embedded within primary care aimed at improving risk assessment or management for women after hypertensive disorders of pregnancy. The study aim was to co-design an intervention to improve implementation of cardiovascular disease risk assessment and management following hypertensive disorders of pregnancy for primary care settings in a local health district in New South Wales, Australia. Method Using the Integrated Knowledge Translation framework, a series of five co-design meetings with the investigative team and end users were conducted online. Meetings were informed by the Behaviour Change Wheel framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys and an online discussion. Data from activities and audio recordings following each meeting were analysed thematically using inductive–deductive thematic analysis. Results were summarized after each meeting, and findings used to inform ongoing intervention development. Results The 18 end users included women with lived experience of hypertensive disorders of pregnancy ( n  = 8), obstetricians ( n  = 2), midwives ( n  = 5) and general practitioners ( n  = 3). Target priorities were to improve communication between hospital staff and general practitioners following the occurrence of hypertensive disorders of pregnancy and increase the knowledge of general practitioners and women regarding cardiovascular disease prevention after cardiometabolic pregnancy complications. Part 1 of the intervention is set within the hospital setting and delivered via physical resources to address the communication gap between hospital and primary care providers about the occurrence of hypertensive disorders of pregnancy. Part 2 is delivered via an update to an existing general practice education platform and through resources for use within consultations to provide education for women and general practitioners about cardiovascular disease prevention after hypertensive disorders of pregnancy. Conclusion The Integrated Knowledge Translation and Behaviour Change Wheel frameworks aided in the development of a targeted intervention to improve implementation of cardiovascular risk assessment and management for women after hypertensive disorders of pregnancy, based on gaps identified in current primary care practice.