One in five GP practices closed in past decade
WALES is facing a GP surgeries crisis, with one in five practices having closed in the past decade.
Dr Ian Harris, deputy chair of BMA Cymru Wales GP committee is asking a crucial question in “how can we expect family doctors to be there for us when GP services have gradually and systematically been starved of funding?”
He claims problems in general practice across Wales can be summed up in three words – workload, workforce and wellbeing.
He warns that despite calls for the Welsh Government to take action to help the profession, surgeries are “heading for the cliff edge and fast, without immediate action to reverse funding cuts, the future of GP services in Wales is bleak.”
He added: “Our workload has grown dramatically, an ageing population, surgery closures, a rising rate of chronic illness and having to provide more complex care has created an overwhelming volume of work. While the demands on the service increase, the workforce has shrunk, and we are now treating more patients than ever before with an average rise in patients of 23% per GP thanks to the closure of 94 practices and a decline of 21% of full time GPS.”
Inevitably, Dr Harris said the wellbeing of GPS has suffered as a result, with a rise in mental health issues, with many leaving the profession they love and handing back their surgery keys.
He said: “Many colleagues have gone part-time to cope with the rigours of the job,working full weeks of 12-hour days making potentially life and death decisions takes its toll.”
Last year BMA Cymru Wales launched the Save Our Surgeries Campaign, calling on the Welsh Government to take several steps. These are to commit adequate funding of General Practice, restoring the proportion of the NHS Wales budget spent directly on practices. Secondly to invest in the workforce of General Practice, allowing doctors to maintain safe and high-quality service. And finally, pressing for the production of a workforce strategy to ensure that Wales trains, recruits, and retains its GPS, as well as an overarching long-term strategy to improve staff wellbeing.
Dr Harris said that months on from making those pleas to the powers-that-be, there has been little progress.
He added: “Despite widespread acknowledgment of these issues by the Welsh Government and NHS Wales, little has been done to address them. Public support is strong, with over 21,500 signatures on a petition for better GP resourcing. However, the percentage of NHS Wales spending on GP services has dropped significantly. How can we expect family doctors to be there for us when they’ve been gradually and systematically starved of funding for so long?”
Turning to personal experience Dr Harris said: “I’ve seen this in my own practice. In 2001, we had 14,000 patients, we now have over 18,000 patients but with the same number of full-time equivalent GPS dealing with the workload. Last year, 20 million appointments were held at GP surgeries in Wales.”
On the patient side, Dr Harris said that “they tell us they are pleased with the care they receive, but they are waiting longer to see us as we don’t have enough GPS and staff to see them”.
He added: “Access problems and waiting times are a consequence of a system where capacity cannot meet demand, hurting morale and wellbeing. The patients aren’t getting the care as quickly as we feel they deserve it. Increasing numbers of GPS are leaving the profession, we cannot afford to lose them.”
A lack of work for locum GPS and more private GP practices setting up, the issue is a pressing one for many NHS practices, who are facing rising running costs.
Dr Harris said: “Locum GPS can’t find work because there aren’t the funds to employ them. Private GP services are popping up across Wales.
“NHS practices are worrying about surviving the next year with rising costs. Local health boards are being bailed out by the Welsh Government, while GP surgeries receive real term cuts in funding and have more work passed to them by hospitals as waiting lists spiral.”
A Welsh Government spokesperson said: “As is the trend across the UK, there is a shift towards larger GP practices, with a wider mix of professionals in one setting, providing a greater range of services. The number of GPS and wider practice staff in Wales has increased in recent years, and the current recruitment target of 160 new GP trainees each year is consistently being exceeded – a total of 183 new GP trainees were recruited in 2023.
“We greatly value the work GPS, and all practice staff, do every day. We are working to reduce pressure on GPS, through the introduction of NHS 111 Wales and increasing the services community pharmacists provide. GP contract reforms have helped reduce bureaucracy and free up more time for GPS to see patients. We will continue to work with BMA Cymru Wales on solutions to sustainability issues in general practice.”