Dr Gareth Oelmann delivers GPCW annual report to the Welsh Conference of LMCs

Addressing the Welsh conference of representatives of local medical committees, Dr Gareth Oelmann, Chair of GPC Wales said:

"May I start by thanking you all, the Conference of Welsh LMCs, for the invite to make my first Chair’s address.

In thanking you for the honour, I must in turn thank all those who have stood here before me, for the inspiration, guidance, mentorship, support and friendship that I have already been given in my tenure as Chair.

It has been said “We don’t have an Access issue in General practice – we have a capacity issue”. Never has this been a truer statement.

Chronic workforce shortages, increasing patient demand & complexity, inflationary pressures, energy costs have all combined to mean that resilience, sustainability and escalation are rapidly being overtaken by real concerns of practice viability.

10 years ago there were 470 GP practices in Wales – today this figure stands at 386. Is this ‘the survival of the fittest’ or actually the ‘landscape of extinction’?

The Covid pandemic has undoubtedly changed the face of general practice forever and affected the delivery of general practice in Wales in many ways. To a certain extent, this has dictated and dominated the committee agenda over the last 3 years.

As a team we have navigated the dynamic clinical and political challenges. The safety and wellbeing of our members during the pandemic has been, and continues to be, the absolute priority, whilst also ensuring practices have been able to operate in a stable economic environment.

By now we are supposed to be deep into the Post Covid reset & recovery – if there is truly such a thing as Post covid?

Backlogs in secondary care waiting lists show no signs of waning & this continues to create pressures at the GP front door.

Decreased immunity in vulnerable patients, young & old, due to consecutive years of necessary social distancing & mask wearing has left the community exposed to concurrent waves of Winter Respiratory illnesses.

In exposing the community, it has further exposed the vulnerabilities of a frail NHS in Wales - chronically under resourced and understaffed.

The frailty across the whole NHS landscape is now so acute we are seeing daily headlines dominating the news:-

• Major ambulance delays – or now simply ‘no sends’
• Underfunded Social and Community Care services meaning patients cannot be safely stepped down to more appropriate non-acute settings
• Requests from NHS leaders for clinicians to lower the threshold for discharge
• Political risk is continually being transferred to clinicians, patients, families and carers.

Despite our repeated warnings, our fears have been realised, colleagues are reporting instances where they themselves have driven patients to hospital, or provided emergency care in inappropriate settings due to the inability of the ambulance service to cope. This cannot be accepted as normal business.

It is time to draw a line in the sand….we are contracted to provide General Medical Services – Not Ambulance Services or Social Services!

As a branch of practice we are not alone in facing these pressures. This winter has already seen strikes from our nursing and ambulance colleagues, together with calls for industrial action from junior doctors.

With a significant proportion of our profession operating as independent contractors, GPs are in a very different position in terms of industrial action, but we stand firm in support of the wider community of NHS workers in their calls for pay uplifts and better terms of service, reflective of the vital roles they play in keeping our patients healthy and safe.

Following extensive tripartite negotiations, back in October, we reached a GMS contract deal with Welsh Government. Against the backdrop of considerable national fiscal constraints, we fought hard to ensure the best deal possible for GPs in Wales.

The package resulting from this year’s set of negotiations was unique in the sense that it encompasses both financial and non-financial in-year changes for 2022-23. It also lays the groundwork for the proposed Unified Contract reforms which are set to begin next year, subject to consultation and ministerial agreement.

The agreement is about more than pay alone. The pay uplift and expenses award are below inflation, but this is balanced by consolidation of funding mechanisms and by reduced bureaucracy in the contract. This means a lighter administrative burden and frees up GPs to do what they are trained to do – to treat and see patients.

It doesn’t push the bounds of credibility to suggest that the forthcoming year represents a defining moment for the NHS and general practice in Wales.

The significant challenges of chronic workforce shortages, years of underinvestment and backlogs in both primary and secondary care cannot be underestimated. But in the shifting landscape of primary care, it is paramount that general practitioners have active representation at collaborative, health board and Welsh Government levels. The ‘Reset and Recovery’, together with a redefined contract provides an opportunity to fight for vital additional investment and resource in order to build a workforce that can match the prevailing workload demands.

One of the cornerstones of the success of the GPC Wales committee is the strength of the relationship with you - our LMCs and practices across the length and breadth of Wales.

There are significant and ongoing challenges for LMCs, BMA, GPCs and GPDF, highlighted by the increasingly divergent needs in the devolved nations to develop and support a sustainable primary care, whilst remaining representative to all our members, be they independent contractors, sessional or trainees.

Now, more than ever, the NHS in Wales needs a highly functioning primary care. We have the opportunity and the voice on a national stage, to champion the role of general practice in leading the recovery.

Let us be bold, let us innovate, but above all let us unite, as together we shall demonstrate our commitment to fight for general practice. Do not underestimate our collective strength as a profession"

Ends

Notes to editors

The BMA is a professional association and trade union representing and negotiating on behalf of all doctors in the UK. A leading voice advocating for outstanding health care and a healthy population. An association providing members with excellent individual services and support throughout their lives.