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Key to the success of the NHS in Wales is the dedication, skill and expertise of NHS staff. As we approach the elections to the Welsh Assembly, BMA Cymru Wales calls on all political parties to commit to working to secure a sustainable NHS workforce for Wales and this is particularly urgent for primary care.
Currently there is a crisis in the recruitment, training and retention of GPs and practice nurses. General practice in Wales is primarily delivered through GP Partnerships where GPs lead teams of staff delivering a wide range of primary and community care services to their patients.
This model of care is recognised as being the most effective in ensuring the long-term sustainability of the NHS, through its demonstration of value for money, ability to lead, respond and adapt to service change, and capacity to thrive with minimal outside management.
However years of underinvestment has resulted in at least 10 practices being managed by LHBs with as many as a further 8 at risk of closure. Practices managed by health boards are expensive and the level of external management effort required to oversee them is disproportionate.
The reasons behind the primary care crisis are complex, but at the heart of the problem is the challenge of recruitment and retention. Fundamentally there are too many GP vacancies in Wales which cannot be filled. 1 in 3 GPs will be over 55 in Wales in the next five years at a time when the average age for men to leave general practice is 54 and women 45.
Why is it hard to recruit? GPs have seen their work escalate as the NHS in Wales has closed too many beds, too quickly, without first providing the community capacity and resources that are needed to provide quality, safe, sustainable community based care.
The incredible intensity of modern general practice is relentless - GP principals cannot be expected to work at such a frantic pace. Burnout has led to a flurry of retirements and GP practices closing. For those remaining in work, many are facing no option but to work less days (which reduces the availability of clinical staff to Welsh patients) or to work on a freelance basis rather than take on the responsibilities and anxiety of running a business on a background of diminishing resources and increasing workload burden.
The take home pay for GPs in Wales is reported to have fallen by 25% over the last 10 years. Rising expenses for GP practices (in particular, indemnity insurance and imposed NI and pension changes) have also led to sustainability problems for practices who, in simple terms, see their income and funding eroded year on year.
Restrictions to funding has meant that there has been a decline in the primary care estate. Buying in to decrepit premises is not attractive to anyone, and certainly not to those able to be selective about where, when and how they work.
To overcome these barriers the fundamental mind set of how we all look at primary care needs to change. By listening to and valuing the primary care workforce we have, we can work together to join up primary and secondary care. There may be a transitional cost to pulling work from hospitals, but this funding has to be found. Challenges in accessing appropriate and timely secondary care as well as problems with IT and communications have to be fixed. Workforce pressures across general practice and community care teams need to be properly and quickly addressed.
It must be recognised that redressing the under-investment in primary care is cheaper than the wider introduction of health board managed practices.
We must get back to a situation in which GPs are valued and ‘looked after’ in Wales – generating time and space to teach students and the next generation of GPs. Then we might fill our training posts not only to today’s numbers, but the numbers we need to replace those GPs already being lost.
BMA Cymru Wales is confident that the traditional practice partnership model is fit for purpose provided it is given the resources and investment it needs. Whilst the short-term pressures on the system have made it difficult to sustain, the importance of sustaining it remains clear. Primary care needs government and health board support if it is to survive – and our patients and our nation need and deserve it to survive.
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