General practice faces inequitable care conundrum

by Gareth Oelmann

The focus on NHS waiting times must not overshadow the crisis in general practice in Wales

Location: Wales
Published: Monday 17 June 2024
Gareth Oelmann

In the shadow of the towering NHS conversation, which has largely focused on waiting times and secondary care, there lies a crisis in primary care that is dangerously overlooked but which impacts us all.

Since 2013, almost 100 GP surgeries have had to close their doors, with demand far outstretching capacity, and the GPs remaining now looking after a shocking 33% more patients each.

This unsustainable workload is forcing GPs to reduce their sessions for the sake of their health and wellbeing, the rise in doctors moving away from the partnership model is a testament to this growing trend as managing a business and 12-hour days making life-and-death decisions are unsustainable.

But where does this leave patients when we know continuity of care has been proven to improve long-term health outcomes?

If urgent action isn't taken, general practise could become a dentistry type model, where care is inequitable, we’re now seeing many more patients that have accessed treatment in the private sector and we’re concerned that the rising demand will mean patients face waiting lists to see a GP.

NHS spending on GP services has dropped from 8.7% in 2005 to 6.11% in 2022/23, and likely to have sunk even lower for 2024 and yet demand for services has never been higher.

The BMA’s Save Our Surgeries campaign has been shining a light on the pressures facing GPs in Wales. What has brought General Practice to the brink? Workload, Workforce, and Wellbeing—three words which encapsulate the predicament in Wales.

The workload for GPs has surged, meanwhile the workforce has dwindled; despite government promises, the number of full-time GPs has plummeted by 24% since 2013, with a fifth of all GP practices closing their doors.

The health and wellbeing of GPs is in jeopardy as they struggle to keep their practices afloat. The “Save Our Surgeries” campaign, launched in 2023, and calls for the Welsh Government to take decisive action.

It demands adequate funding, investment in the workforce, a comprehensive workforce strategy, and a focus on improving staff wellbeing. The public has voiced their support for this urgent action, with over 21,500 signatures on a Senedd petition for fair resourcing of general practice.

The stark reality is that the percentage of NHS spending on GP services has been slashed by a third over the past 18 years, while the workload has only increased.

Patients appreciate the care they receive but are frustrated by the increasing wait times due to the shortage of GPs and staff. The system is beyond capacity and unable to meet demand, affecting morale and delaying the delivery of required care.

The exodus of GPs from the profession is accelerating, and locum GPs struggle to find work due to financial constraints in practices. Private GP services are appearing, and NHS practices face uncertain futures with rising costs.

Local Health Boards rely on bailouts from the Welsh Government, while GP surgeries endure cuts and an influx of work from hospitals with spiralling waiting lists. Paradoxically, health board managed practices cost the Welsh Government a third more (33%) and offer fewer services to patients.

Last year, GP surgeries in Wales delivered 20 million appointments. But with the current trajectory, we’re heading towards a precipice. Urgent action to reverse funding cuts is required, because the future of the NHS without GPs is bleak.

The question remains: If not now, when? The time for action is well overdue.

The Welsh Government must heed the call to safeguard the future of general practice before it’s too late, ensuring that our family doctors can continue to be there for us when we need them most.


Gareth Oelmann is chair of the BMA Cymru Wales general practice committee