Seven surgeries across the county borough could be “at risk” of being unsustainable in the near future, it was announced yesterday.
The figure was provided at a meeting between representatives from Betsi Cadwaladr University Health Board and members of Wrexham Council’s Safeguarding Communities & Wellbeing Scrutiny Committee.
The meeting with the representatives, which takes place every six months, saw members of the committee question and raise serious concerns about the current levels of GP provision in Wrexham.
One question, posed by Cllr Beverly Parry-Jones focused on the staffing issues at Pen-y-Maes Health Centre in Summerhill, which has been managed by Betsi Cadwaladr University Health Board since the end of 2016.
Cllr Parry-Jones asked: “How many surgeries are Betsi aware of where this problem is going to happen in the future and what lessons have they learnt from Pen-y-Maes and Forge Road?
“From where I am sat, this problem is looking to runaway throughout North Wales. People in Wrexham County Borough and North Wales have the right to a better quality.
“What if anything are you going to put in place to stop this fiasco happening in another surgery?”
The committee was told there are 11 practices across North Wales that are “at risk”, with seven of those being in Wrexham. Of the surgeries, three are located in the town centre, two in the north of Wrexham and two in the south. Gardden Road Surgery in Rhos and Strathmore in the town were described as being of ‘very high risk’
However representatives did move to offer assurance to the committee, explaining that while they may be classed as ‘high risk’, there is no guarantee the GPs will hand in the contracts and step down from the practice in the near future.
Commenting on when GP practices hand their contracts to Betsi Cadwaladr, Doctor Bowdler explained that the first preference is to continue under GMS (General Medical Service) and therefore go out to tender and advertise the position.
He added: “The Welsh Government set out a sustainability matrix which is a series of parameters with which we look at practice and see the level of risk they are likely to be unsustainable in the near future.
“We have done that for all practices across Betsi Cadwaladr, in our particular area there are 11 practices are at risk, three of which at very high risk. Already met with one practice and meetings arranged with other two practices at very high risk.
“The sort of emergency help we can offer is to look at the skill mix in place and their systems to see they are delegated as much as they possibly can.
“But my longer-term hope is if we can get things like a home visiting service set up, if we can get back office functions delivered by a good admin team, we might be able to deliver for those practices that are struggling.
“Most of the practices when they approach us, their main thing is they want us to help them recruit another GP or two and that’s the one thing we too are struggling to deliver.
Rob Smith from Betsi Cadwaladr University Health Board added: “It is not an exact science with risk assessments. When we have done this before it hasn’t always been a good indicator of when a practice will topple over or not.
“The others, because it’s people working with their own working lives, their own decision making for their own independent practices. So Gareth and the team are making as good an assessment as possible where that risk is. I think this is a good assessment based on what we know.
“We’ve had other practices that have given their notices where we’ve not seen it to be the case as they work individual practices and make own decisions.
“The ones talked about here, it is not a new situation. Some have been at a similar risk probably, certainly for the two years I’ve been involved, at that level of risk for that time. It is a balance of perspective of what’s happening .
“Yes at they’re at that risk, is it an indication they will definitely give in contracts in the foreseeable future? It is impossible to know. Are there others that are in similar position that we haven’t identified as being at risk that may make different decisions. It is difficult to know.
“We have got to make our best assessment where those risks are and provide as much support as we can.”
Cllr I David Bithell said: “I think residents of Wrexham will be concerned and alarmed about seven practices under very high risk of closure. What emergency plans are in place if the worst case scenario if happened today?”
Explaining the process in place, Mr Smith said: “We would immediately advertise for other GMS contracts. That previously has not been successful. If that does not happen, the plan for those practices, approved last week, sets out the staffing required and we would roll that into action and ensure the services are sustained.”
The meeting was also told of a series of priorities currently being looked into by the health board to ‘remodel’ the services they currently offer.
Doctor Bowdler explained that the first priority of the health board is provide surgeries through GMS contracts as a first priority and where that is not deliverable they will be managed by Betsi Cadwaladr.
He also noted that there are plans to remodel the service, with four key focus points, including improving the same day service and ensuring that when a person is unwell, they are able to see as soon as possible.
Home visiting services and routine care would also be looked at, with Doctor Bowler referencing a system in Prestatyn whereby there are core teams where each patient has a “team” with a named clinician that they belong to.
The final point listed was back office functions, with Doctor Bowler explaining that medical secretaries could be employed to deal with paperwork and therefore creating time for the GPs.
During the debate a number of councillors raised concerns about issues with GP recruitment in the Wrexham area, with many calling for assurances that the health board will do more to recruit GPs and tackle the issues being faced by thousands of patients across Wrexham.
Cllr Brain Cameron said that conversations had taken place over the past three and a half years about GP recruitment, noting that “no matter who you speak to in the county borough, all these patients have difficulty in getting in to see a GP”.
He continued: “It all boils down to the same thing, there is a shortage of GPs. We have been talking about this particular issue for very nearly three and a half years. What confidence can you give this committee and the people of the county borough that we are going to get somewhere on the recruitment of GPs.
“We can do all these things, but unless we get to crux of the shortage of GPs, we’re not going to get anywhere. My concern is we haven’t got a plan on recruiting GPs.”
Cllr Cameron added: “The people of Wrexham and North Wales deserve to be able to see a GP, not a receptionist as people are telling us. They’re not trained. People need to have the confidence in the service being delivered by the health board.”
Doctor Bowdler said: “We’ve been talking about this as a profession for possibly ten years or more.
“There is not been enough recruitment and we’ve not recruited enough GPs to replace those that are leaving and to meet the demands on the service.
“Number two, over the last ten years the funding levels for general practice have barely increased. That has translated into a reduction in GP partner income. For doctor’s looking at GP practice compared to a hospital has become less of an attractive option. For those two reasons I believe there is a national shortage.
“Competitively we are up against it in England. Unlike in the west their recruitment is a little better, because pretty much if someone wants to work in the west they do it for family reasons. Or because they are from Anglesey and they have a personal connection and they’re not going to look for work in Chester.
“If you’re living in this area you have easy access to commute to Liverpool or Manchester, much more competitive round here.”
“There’s a much more pay differential in England and Wales, which must contribute to some extent if you choose to work here or in England. We are offering the max salary we are permitted to offer in Wales, what we have got to try and do is offer better condition of employment, if we can’t increase the pay we have got to make sure the job is more interesting or less stressful.”
“We are exploring as much as we can to get the skill mix and a strong support team for the GPs, so because, they might not be earning as much, but the job is more interesting and less pressurised.”
Questions were also asked about Pen-y-Maes surgery in Summerhill, with growing concerns and criticism from patients about inadequate staffing and the management of the facility since Betsi Cadwaladr took over last October.
Prior to this morning’s meeting a number of patients at the surgery staged a protest outside the Guildhall, calling on the health board to improve the service at Pen-y-Maes.
Cllr Nigel Williams said: “One of my main concerns and it’s been well advertised, there’s a lot of people outside today, is about Pen-y-Maes surgery.
“The patients have been let down over the last 12 months. There should be four GPs there, sometimes there’s one, sometimes there’s two and sometimes none at all. It’s all very well saying there are other health professionals there, which is great, but we still need GPs there as well. What are you doing to address this?”
Doctor Bowdler noted that there was a national issue with recruiting GPs and that the health board was not exempt from that. He continued: “We’re trying to upturn every stone we can to recruit more GPs because the model doesn’t work without any GPs at all.
“What we have to do is try to make do the best we can if we can only recruit three GPs where previously we might need five. We need to have other people, which is why the emphasis is on a skill mix.”
Commenting on the recruitment process, Doctor Bowdler noted there was an ongoing rolling advert online and that enquiries are being made to undertake international recruitment in the EU.
Cllr Williams also called for reassurance over the health board’s plans for Forge Road Surgery in Southsea, which is due to be taken over by Betsi Cadwaladr in the new year.
He said: “Forge Road is the next practice along. The doctors are due to leave and retire in January and they own the surgery.
“I met with someone from your department five weeks ago, planning another meeting in two weeks, they’ve not come back to me, about where the next surgery will be. What assurances can you give residents in that area that from January there will be a surgery to walk into
Doctor Bowdler said: “With the premises, the GPs do own the building. As to what they choose to do we are not aware of that at the moment.
“We want to keep the service there for the time being. There are plans in place for clinicians on site to provide appointments for patients. I don’t have the rota to hand, but is it place.
Cllr Gwenfair Jones also called for reassurance that the health board didn’t have plans to create one large surgery for the Wrexham area – asking if there were a plans to provide such a service. Mr Smith said that it was not the case, and such a plan is not being considered.
You can read two further reports from this meeting: