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by Gareth Thomas
8 December 2023

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Freezing staff recruitment to cutting back on heating – the financial challenges facing general practice in Wales

Negotiations to agree an uplift to the GP contract in Wales have ended with no resolution forcing practice managers to make tough decisions around practice budgets. Gareth Thomas describes the stark effect that funding gaps are having on the ground

As a business manager in a practice in South Wales, I have experienced first-hand the detrimental effects of continued underfunding in general practice by Welsh Government.

The Save Our Surgeries campaign, launched in the summer and spearheaded by the BMA, has also highlighted the severe impact of long-term underinvestment on workload, with the alarming statistic that 80% of GPs in Wales fear they are unable to provide quality and safe care to patients due to their excessive workloads, diminishing workforce, and the rising demands of the service.

A total of 91 surgeries have closed since 2013, meaning Wales is coping with 20% fewer surgeries at a time when pressures on health services are at critical levels.

The BMA’s GP Committee Wales (GPC Wales) has made it clear that without an increase in funding from the Welsh Government the future of general practice in Wales is at risk of collapsing.

It has now taken further action and recently launched a Senedd petition, that demands ‘fair and adequate resourcing of general practice’. As the time of this blog being published, it had received more than 9,410 signatures. Petitions with more than 10,000 signatures will be considered for a debate in the Senedd.

With limited financial resources, we are forced to navigate the daunting task of stretching our practice budgets while ensuring the provision of general medical services. The strain that this places on the entire practice team is immeasurable. Resources are also being squeezed as we have to manage the significant rising costs of maintaining and running practice estates.

Underfunding directly damages recruitment and retention because we simply cannot afford attractive levels of pay that keeps people in the job.

We are already seeing clinical and non-clinical staff leave general practice. In the last nine months, my practice has lost two very experienced advanced nurse practitioners and five reception staff. My management apprentice has also handed in his notice since we cannot compete with the financial recognition and incentives he can command in the private sector.

It has become challenging to attract talented doctors, nurses, and back-office staff when salaries fail to reflect their expertise and dedication. This ultimately leads to staff shortages, increased workload, and burnout. Subsequently, patient care and access to services suffer as the continuous strain makes it difficult for practices to maintain services.

Under the general practice escalation tool, used by local health boards to gauge level of demand and pressures, many practices have had to report working at a higher ‘escalation level’.

The paused contract negotiations between the Welsh Government and GPC Wales has further exacerbated the challenges we face. The lack of progress and acknowledgement of our concerns perpetuates a sense of under appreciation and disillusionment among general practice staff.

Negotiations should be seen as an opportunity to address funding gaps and secure a sustainable future for general practice. However, the delays by Welsh Government reflect a lack of recognition and understanding of the critical role we play in providing general medical services in our communities.

The consequences of this current impasse are far-reaching. Without a clear agreement, it becomes difficult for practice managers to plan with their GP partners and allocate resources effectively.  

Practice managers will be forced to take drastic cost-cutting steps. These could include freezing recruitment, halting staff overtime, stopping use of GP locums, reducing services, and turning off heating and lighting – the list goes on. This will further dampen the motivation and morale of the key practice manager community, again affecting staff retention, and potentially leading to even more of a decline in patient access.

Of course, Welsh Government could impose a contract, but this will not answer the fundamental question of why it is choosing to ignore the pleas from professionals on the frontline.

Recently, I invited all Vale of Glamorgan Members of the Senedd to visit the practice and witness first-hand the pressures we face. I had a response from Jane Hutt (MS for Vale of Glamorgan), a former minister for health and social services. Her response was disappointing, blaming the lack of funding on the UK Government and explaining that the financial offer on the table from the Welsh Government around the GP contract (that includes only a 5% uplift for the pay element of the contract) was all it could afford.

I find this hard to believe – health is a devolved responsibility in Wales and for a long time has received £1.20 for every £1 spent in England per head of population. It seems that underfunding has been a direct consequence of priorities by Welsh Government and not a lack of funds.

My senior GP partner and I also met with Rt Hon Alun Cairns, the Conservative MP for Vale of Glamorgan. Interestingly, he expressed disappointment that the recent GP contract negotiations have failed to reach a satisfactory outcome. He listened to our concerns but we need someone to take action.

The Institute for General Practice Management (IGPM), for which I am the national lead in Wales, also wrote to the minister for health and social services, Eluned Morgan MS, at the end of October outlining our concerns. We still await a reply.

It is imperative that Welsh Government urgently re-engages with GPC Wales by presenting a realistic offer that includes fair funding, transparent allocation of resources, and a greater slice of the overall NHS budget. We also need ongoing, open dialogue.

Without the proper resources, patients may start to experience more delays in receiving GP services they need and deserve. This not only compromises patient outcomes but will place unnecessary burdens on other parts of the Welsh NHS system.

It is time for general practice to be prioritised – and fast.

Gareth Thomas MSc is business manager at West Quay Medical Centre in Barry, South Wales and national lead (Wales) at the Institute General Practice Management