The number of patients registered to an individual General Practitioner in Wrexham is higher than average – however there were reassurances that more is being done to recruit GPs in Wrexham.
The figure was provided at a meeting between members of Wrexham Council’s safeguarding, communities and wellbeing scrutiny committee and representatives from Betsi Cadwaladr University Health Board yesterday afternoon.
It was the first time that councillors had been updated on progress with GP recruitment and progress with improving primary care in Wrexham in 12 months.
Dr Gareth Bowdler, eastern area medical director for Betsi Cadwaladr University Health Board, explained that the challenges faced by the health board and recruiting GPs were very much the same as the last meeting.
However during the period between meetings regular reviews and risk assessments had been carried out with all local practices, along with support from the health board.
As a result the meeting was told there had been no resignations in the Wrexham area in the past 12 months.
Dr Bowdler continued: “The clusters all have GP cluster leads now and are all actively working on innovative approaches to develop and modernise primary care in the area – for example encouraging physios and pharmacists to work within practices.
“The north west Wrexham cluster has recently started a home visiting service led by a colleague in the Wales Ambulance Service. He is visiting patients during the day which otherwise would need a GP to visit them, which is proving very popular and helping with recruitment in that area.”
Cllr Ronnie Prince queried if there was ratio of GPs per the number of people living in Wrexham and what preventative actions have been put in place to reduce demand in the future.
Dr Bowdler said: “There isn’t a minimum standard on the number of whole time equivalent GPs on patients. The average in North Wales is round about 1800 patients to a whole time equivalent GP, which is a little bit higher than the UK as a whole.
“In Wrexham it is higher again, just over 2000 patients per the equivalent of a whole time GP, which is one of the highest in the UK. Which definitely demonstrates that this area is particularly difficult to recruit to and has a much higher that normal list size.
“Some examples of preventative work include a lot of pharmacists are commissioned to carry out smoking cessation therapy. They will be able to supply the person attending pharmacists with advice and counselling the person needs.
“We have a business case in place for diabetics. If you look at the low calorie diet there has been research published showing that if someone who has been newly diagnosed with diabetes who agrees to go on this programme can reverse that diagnoses and go into remission, which is something highly desirable.”
In terms of GP recruitment – a long running issue not just in Wrexham but across the country – the committee was told that ‘alternative models’ for practices were being looked at.
This includes offering a range of expertise and options for patients aside from GPs – such as advanced nurse practitioners, nursing staff, physiotherapists, pharmacists and mental health practitioners.
Janet Ellis, assistant medical director for primary care in the east, said there is an opportunity to “role out a transformational model” and develop the way in which primary care services are delivered.
She added: “We have done things to assist with winter pressures. Most practices have taken up the offer of providing additional sessions in their practices to see more patients, which has been successful in the east and in Wrexham.
“The other thing is we are one of two pilots in North Wales using Welsh Government funding for out of hours. It is a pilot project run by the cluster in south Wrexham and working with out of hours.
“It is very early days and will not be reporting back to Welsh Government until next month. But it’s really promising and looks like it is helping with the pressures we are under.”
Dr Bowdler explained that there are negotiations to hand back three practices in Wrexham which are currently managed by the health board – Borras, Hill Crest and Forge Road – to an alternative provider.
He continued: “We are in negotiations with a preferred provider and we are very excited about the model they are going to offer. They are going to deliver services from those sites through what’s called a community interest company.
“This a non for profit organisation, but has the advantages of being able to draw down social funding and draw down funding from charitable enterprises, which otherwise would not be available to normal GMS (General Medical Services) practices.
“So there is potential to not only bring additional funding and expertise, but business development.
“We met yesterday to try and keep that momentum going and we hope to get a paper and approval in March.”
Cllr I David Bithell said: “I am pleased to hear that three GP services are moving forward to having permanent GPs. Can you assure me they will have long term contracts and you won’t have to rely on locums in the future?”
Dr Bowdler said: “There are negotiations with two full time doctors who have identified a handful of others willing to work.
“The contract we will be offering them will be an indefinite, permanent contract. One thing we have insisted on is that it is a stable and long term plan and not based on locums.”
He added: “With recruitment, an area which is the biggest challenge, we are doing a lot of work.
“We have been going to lots of national conferences, we have held open events nearby inviting GPs and advanced nurse practitioners to come to the area and showcase what we do.”
Cllr Brian Cameron said he “couldn’t see the light at the end of the tunnel” in terms of current pressures on GP surgeries – and asked what provision had been put in place to meet the increased demand on services with the 8,500 homes in the Local Development Plan (LDP).
He said: “GP recruitment was raised in back September 2012 and it has been a constant problem to the residents of Wrexham. I’d be encouraged to understand what improvements have we had.
“I am concerned because there seems to be the shortage of GPs and the difficulty people have having getting into GP practices seems to be getting more and more difficult.
“I can’t see any light of the tunnel especially with an LDP with an extra 8,500 properties coming into Wrexham.”
Dr Bowdler explained he wasn’t aware of any specific plans to address that increase in the population.
He continued: “What happens normally if there is an influx of new people into the area, the way the funding formula works is that additional funding is made available to whatever practice those patients register with.
“If in my practice I get an extra 500 patients suddenly registering then my budget will increase accordingly to enable me to recruit additional staff.
“It does then raise the question if it’s difficult to recruit even if you’ve got the money what are you going to do? We are constantly looking at new ways of working. If we can only recruit a small number of GPs how can we use other people’s skills to look after those additional people?
“There has been a lot of interest currently going into care homes, which require a lot of attention. People who live there are very elderly and have a lot of medical problems and need regular visits. They also need continuity of care.
“If you have temporary staff going in and out, that is not a good service. We have been putting interest into providing a more bespoke, dedicated service for people in care homes.
“So you’ve got a regular team of people going in and developing relationships with the staff there. That is one innovation that could help reduce overall demand on regular GMS practices.”
One recurring topic raised throughout the meeting was the increased use of ‘social prescribing’ by GPs as a means to refer patients to other non clinical services.
This can include finding support to patients suffering from loneliness and isolation – including utilising the many community agents in place in Wrexham and other local facilities.
Mr Bowdler said: “If someone is presenting to you a myriad of problems but the thing that would make the biggest difference to their wellbeing is more contact and help with certain things in their lives, there are organisations like the Rainbow Service in Penley that can help support people with befriending services, introduce them to walking clubs and the Mens Shed groups.
“This might not sound like a lot to do with health, but what we know is the impact on social isolation on elderly people is enormous and as a result they require a lot more help then they otherwise would if they were being well looked after.
“When you’re living on your own, you are going to suffer a lot of mental illness.”
Rob Smith, area director at Betsi Cadwaladwr University Health Board added: “Research showed recently there’s a greater linkage around social isolation and early death rather than smoking, obesity and other indicators you may expect to see.
“Social isolation is key indicator that we need to be dealing with in terms of support for the local community. That’s why social prescribing is so important.”
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