BMA Cymru Wales leaders gave a stark warning to this month’s Senedd inquiry into the future of general practice: tackle the GP funding crisis or watch the NHS in Wales crumble.
Gareth Oelmann (pictured) and Ian Harris, chair and deputy chair of the BMA general practitioners committee Wales, were part of an expert panel of GPs appearing before the health and social care committee on 17 September, in the inquiry’s second formal evidence session.
The inquiry is a direct response to the BMA Wales’ Save Our Surgeries campaign and ‘longitudinal’ lobbying over the past three years to amplify general practice’s voice.
Throughout the 90-minute Q&A session, Dr Oelmann and Dr Harris stressed the urgent need to restore the GP share of the NHS Wales budget from the current 6.01 per cent to 2005/06 levels of 8.7 per cent within three years.
As Dr Harris, a GP partner in Bridgend, put it: ‘Over the years, we’ve been asked to do more and more and more with a reduced proportion of the NHS spend.’
Preventive approach
The answer did not lie in ‘robbing Peter to pay Paul’ and defunding secondary care. ‘New money’, such as has been found for tackling hospital waiting lists, might be needed.
Doctors across all branches of practice agreed that a stronger policy focus on preventive health was key to tackling the healthcare crisis, said Dr Oelmann after the hearing. ‘If we are moving care closer to home, where it may be more appropriate and more efficiently delivered, then resource must follow cost. And that means less pressure on A&E.’
Dr Harris told that inquiry that reversing the defunding of general practice will require a determined shift in policy which he compared to ‘turning around a super tanker’.
‘The direction of travel with funding and policy over the years has been to relatively defund general practice and primary care in favour of other sectors,’ he said. ‘They're less shiny, enticing areas of healthcare.. but they're so vital to the health of the nation.’
Also critical to a GP ‘rescue package’, says the BMA, is reform of the GMS contract annual negotiation process and decoupling pay from wider contractual change, alongside a move towards multi-year funding strategies.
National insurance
The BMA’s other recommendations in its written submission to the inquiry included addressing the significant financial impact of the rise in national insurance contributions, the need for a national standard for safe working, the unsafe and unsuitable state of some GP estates, and GP shortages and unemployment.
Dr Harris described as ‘Kafkaesque’ the current combination of GP shortages alongside high GP unemployment, largely because practices cannot afford to hire them. Better pay and conditions overseas – and in other parts of the UK – were draining the Welsh workforce too. Wales now has about 700 GPs fewer than the OECD average.
Dr Harris suggested the Welsh Government’s Train Work Live campaign to attract healthcare professionals to train and stay in Wales might be better named Train Work Leave.
Productivity in general practice is high, with 1.6 million appointments delivered each month – but at a significant cost to a workforce suffering high levels of stress and burnout.
‘GP is the best job in the world and the worst job in the world, usually at the same time,’ said Dr Harris. ‘And the thing that makes it the worst job in the world is the attritional nature of the pressure that you feel to deliver services when you don't have the resource.’
Change fundamental
Since 2012, 100 surgeries have closed and GPs are now seeing up to 35 per cent more patients each. A recent BMA survey shows that 89 per cent of GPs in Wales say they are unable to meet patient demand.
Speaking after the inquiry, Dr Oelmann, who is a GP partner in Gwent, said he felt encouraged that GPs’ voices had been heard: ‘It’s important that this platform has given us the opportunity to share frontline realities and influence policy thinking. What we saw at the hearing was widespread cross-party support for the principles we’re putting forward, and an encouragement to pursue them.’
But he also warned: ‘Each and every one of the practices across Wales that we represent are facing the same significant challenges. Without change, general practice will continue to crumble and with it the foundations of the NHS in Wales. No change is not an option.’
BMA recommendations not covered in the session, including the GP estate and digital innovation, will be the subject of further written submissions.
The inquiry, which will continue throughout the autumn, aims to deliver practical recommendations to the Welsh Government, which will then be debated in the Senedd.