As we reach the end of a BMA triennium, we find ourselves at a crucial moment for general practice in Wales and the UK. Our challenges are significant and their scale and intensity are unprecedented. Our patients are fully aware of these issues, our colleagues are experiencing them first-hand and our profession has been pushed to its limits more times than we can count. The urgency of the situation is undeniable.

This is why the theme of our Welsh local medical committee conference this year – ‘If Not Now, When?’ – is incredibly fitting. It reflects the urgency, courage and necessity for transformative change. Through our contract referendum, general practice in Wales delivered a clear message: ‘It's now or never.’ This statement was not just a plea but a firm line in the sand.

A profession under pressure

During the past three years, our teams have faced significant personal and professional challenges. The COVID-19 pandemic has revealed the deep-rooted flaws in our systems. Chronic underfunding, workforce shortages and continuously increasing demand have worsened these problems. Despite these hardships, our GPs, nurses, pharmacists and support staff have shown unwavering dedication to their patients and communities. Their resilience is not only commendable, it is the lifeblood of our NHS and deserves our utmost respect.

Rising to the challenge

During this period, the BMA Welsh general practitioners committee has taken strategic and measured actions to address our profession's primary challenges: workforce, workload and well-being.

During the last three years, we have successfully overseen the implementation of the new unified general medical services contract in Wales, introduced the contract assurance framework, led the Save Our Surgeries campaign and initiated a referendum for our profession in Wales to combat the Welsh Government's inadequate contractual offers.

Launched in 2023, the Save Our Surgeries campaign was more than just a slogan, it was a coordinated grassroots movement. We engaged in letter-writing campaigns, secured Senedd debates and called for a funding inquiry leading up to the 2024 contract referendum. While some questioned our approach, the results are evident: we have witnessed a change in tone, a reassessment of funding priorities, and, most importantly, a profession re-energised by a shared purpose.

A turning point – but not a finishing line

The additional funding we secured this year following the referendum is a positive development. It is important to clarify, while it doesn't resolve all our issues, it does lay a crucial foundation for future improvements. Accepting the in-year stabilisation payment settlement provided practices with the financial stability they urgently needed and demonstrated our unified voice is being heard.

That said, the non-recurrent aspects of this deal are still a concern, and we recognise there is more work ahead. However, we have successfully obtained a commitment from the Welsh Government to begin early negotiations for the 2025–26 GMS contract. We are fully dedicated to advocating for these one-time investments to become sustained, recurring support. If we fail to maintain this progress, we will return to the profession and unite once again to take action.

Reimagining the future

To secure the future of general practice, we must go beyond simply addressing immediate issues, we need to reimagine the entire system.

Our workforce strategy should focus on recruitment, retention, well-being and talent development. We must create a pathway in general practice where doctors, nurses and allied health professionals can survive and thrive.

Investment is needed not just in individuals but in teams. Multidisciplinary collaboration is essential; a robust, cooperative team led by GPs, including pharmacists, physiotherapists, nurses and administrative staff, will form the backbone of sustainable, community-centred care. However, we must navigate the challenge of working in these multidisciplinary teams while ensuring holistic care which emphasises continuity of care.

Additionally, a fairer and more effective funding model is necessary. Simply redistributing a limited budget will not solve the problem, shifting resources around won't keep us afloat. We need an increase in investment that benefits all practices, whether urban or rural, affluent or deprived, large or small.

The road ahead

Our collective achievements in the past three years should not be underestimated. We have highlighted the urgent needs of general practice in Wales and have begun to witness a shift in political will. We have also reminded everyone, from policymakers to patients, that general practice is not just the entry point to the NHS, it is the system's foundation.

We must not let this momentum fade. The road ahead is long but for the first time in a while, we are not walking it alone. We are united as a profession. The importance of our collective action cannot be overstated.

Jeremy Miles, member of the Senedd, the cabinet secretary for health and social services, has shared his vision for transforming health service delivery to ensure care is available closer to home. He has emphasised that general practitioners will play a more significant role in managing waiting lists to reduce delays and improve patient flow in the health system. This includes expanding diagnostic testing in local communities. Additionally, he announced plans to enhance the transparency of health board funding allocated to primary care and outlined intentions to increase this funding over time.

Our strength comes from our unity and collaboration. We are more powerful when we stand together for a common cause. Together, our voice holds significant influence. Through open dialogue, cooperation and steadfast determination, we will advocate for the necessary changes to ensure general practice in Wales remains a sustainable, fulfilling and patient-centred career for future generations.

As we reflect on all we have endured and achieved, I ask again: if not now, when? Every action we take moving forward must address this question. We are at an inflexion point, a journey only half completed.

I look forward to the next three-year cycle with increased enthusiasm and optimism for the future of general practice in Wales.

Gareth Oelmann is chair of the BMA Welsh GPs committee