January 14 2015

The Petitions Committee
National Assembly for Wales

Cardiff Bay

Dear Chair of the Petitions Committee

The Royal College of GPs Wales is grateful for the Minister’s response and his recognition of the pressures facing General Practice.

We were disappointed that his letter did not acknowledge the fall in funding in real terms over the last four years. This shortfall will hinder the essential development of general practice to meet the needs of the Welsh population and the aspirations of the Welsh government. A boost in investment for general practice is vital if we are to meet the changing needs of patients, reduce pressure on the rest of the NHS and place our health service on a stronger long-term financial footing.

Whilst GP workloads are increasing, funding for general practice in Wales has fallen, in real terms, from £451.3m in 2009/10 to £438.0m (HSCIC, September 2014 and Autumn Statement, December 2014) in 2013/14, with total investment falling by 2.9%. This is having a concerning impact on patients – with as many as 650,000 people finding it difficult to get an appointment to see a GP in Wales last year.

There is growing evidence that the capacity of the general practice workforce to meet the changing and increasing demands of patients is under threat. Firstly, demand for general practice is increasing and this is causing additional workload pressures for GPs and their teams. There is also strong evidence that the care general practice is required to deliver is becoming more complex as we are becoming an ageing population.

The general practice workforce is also ageing. In Wales, over 23% of our GPs are over 55 and many are choosing to retire early, often due to work pressures and stress.

Wales ranks third in the UK in GP coverage per population and RCGP Wales estimates that we will need an additional 95 GPs this year just to reach the UK average. We will need even more to replace those who leave and far more to meet the needs and challenges ahead.

The RCGP’s Put Patients First: Back General Practice campaign, a collaborative of General Practice staff and partner organisations, focuses on the need for urgent additional resources as well as focusing on the key themes that are inhibiting GPs from building on the excellent quality of care they currently provide despite these challenges.

We believe that for general practice to play its critical role in caring for patients in the future NHS, it is important that there are enough GPs and practice nurses; that these doctors and nurses have sufficient time, both in and outside the consultation, to understand the patient’s needs and concerns to provide the interventions needed. They need to receive

sufficient training to develop the capabilities required to deliver the high quality services that patients, carers and families rightly expect.

RCGP Wales welcomes the £10m fund identified in the primary care plan but it still falls far short of the investment needed to address the shortfall in funding for general practice alone. General practice received 8.5% of total NHS expenditure in 2005/06, it now receives 7.7%.   The primary care plan mentions the “transfer of resources from hospitals to the community” over the next four years. The Minister has given us no assurance as to whether or how that will happen as it remains within the remit of LHBs to decide how the money is distributed.

Recent research commissioned by the Royal College of GPs shows that an increase in access to general practice would lead to a reduction in the number of A&E attendances in Wales. Estimates place the proportion of attendances that could have been dealt with in general practice at between 15 and 26% and thereby lead to a saving of up to £21.5m each financial year at a cost of £3.5m, rising to annual savings of up to £34m by the end of 2019/20. The economic argument is palpable.

The pressures on general practice to deliver effective care are mounting, as is the need to deliver continuity of care and accessible services. The crisis of demand versus capacity in the health service is not new; it has not arisen overnight and neither can it be solved quickly. Sustainable solutions must be found to increase workforce capacity and enable general practices to continue to deliver the level of service that their patients expect now, as well as taking on the challenge of providing more complex care, spending longer with their patients and communities and taking on new roles and responsibilities.

We hope that the Minister will take action to ensure that investment in general practice is secured for the long-term and that the resources will therefore be made available to meet demand before it is too late.

Yours sincerely,

Paul Myres

Chair

RCGP Wales