Pendyffryn Medical Group
By now, most of the 18,000+ patients registered at Pendyffryn Medical Group in Prestatyn should have received a letter in the post advising them of the intention of the Partners to “resign” as of the end of March. More specifically, the Partners have given the necessary six months’ notice to the Health Board of the termination of their contract with the Health Board to provide “General Medical Services”.
I met with Partners at the practice last week and spoke with the Interim Chief Executive of the Health Board, Simon Dean, to discuss the implications of this and how I could best assist residents affected.
Most patients will simply want to know what this situation means for them. Current arrangements should remain exactly the same as usual until April. The Health Board is ultimately responsible for overseeing the provision of primary care services and from April onwards, they will need to ensure a seamless service is in place. The strong likelihood is that this will be based in the same building and will involve a practice managed directly by the Health Board, employing many if not most of the current staff and clinicians. I suspect this will require additional funding over and above the current practice allocation.
In other words, the key message is that while patients may by all means wish to express their unhappiness at this news and the causes of it, I would encourage them to try not to worry as I know that every effort will be made to retain services. Nevertheless, I will keep a close eye on developments as April approaches to ensure this remains the case.
The Practice states that the reason for its decision is that a combination of retirements and the inability to retain/recruit new GPs risks making future service provision unmanageable.
My grandfather was involved with setting up the then named Prestatyn Central Surgery in the early 1960s and it is today by far the largest GP practice in the town and surrounding areas, with branch surgeries in Ffynnongroyw and Meliden.
Across the country as a whole there have in recent years been closures of a number of GP surgeries but these have mostly been “single handed” practices in difficult inner city areas. The “closure” of a practice of this size has until now been virtually unheard of. I am aware that the Partners at Pendyffryn Medical Group have been making representations to the Health Board and Welsh Assembly Government for some time about their severe struggle to retain or recruit doctors, whether as Partners or in a salaried capacity. There are a number of questions for all parties to answer in this respect and this latest blow to local health services of course comes on top of a catalogue of other concerns which have led to the Health Board being put into special measures.
The practice argues that it has been unable to retain new doctors due to a very high workload. Undoubtedly it currently has fewer doctors than it needs which has presumably placed a great deal of pressure on those who remain. With regard to both retention and recruitment, the area is regarded as a pleasant one in which to work and although it is home to a large number of elderly patients, it is not unique in this respect. Reassuringly, some other practices in the locality have been able to appoint new Partners in recent times.
GP recruitment has become more difficult across much of the UK over the last several years but North Wales is particularly badly affected. I will go into some detail over this as I have been asked to do so by several constituents.
Nationally, a large cohort of the GP workforce has over the last few years been reaching retirement age and increasing numbers have also been retiring early or moving abroad to work, resulting in a the need to replace many posts. The Medical Practices Committee which used to ensure areas most in need of GPs would receive them was abolished in 2002. It is also more difficult than it was in the past for those who have left practice as a GP to return to work and the constraints brought about by the relatively new appraisal and revalidation process tend to discourage those around retirement age from continuing to work part-time. Meanwhile, the appeal of General Practice amongst graduates has reduced and many GP training schemes are not full. This is largely due to the perception and/or reality of increased workload and reduced pay in comparison with other specialities, along with spiralling medical indemnity costs. GP training is also longer and more onerous than in the past. Increasingly, the management of multiple, complex conditions previously overseen in hospitals has moved to the community, and many less challenging conditions are now dealt with by pharmacists and practice nurses. GP appointments however remain at only 10 minutes each, creating long and intense days at work. The availability of potential applicants is also affected by the fact that non-EU immigration rules are now very strict and whereas in the past many doctors came to the UK to work from abroad, this is relatively limited at present. Additionally, those who become GPs are more likely today to wish to work part-time, especially women who form a much greater proportion of the GP workforce than in the past. Finally, there is a feeling that “GP bashing” amongst the media and some politicians combined with in some cases ageing primary care infrastructure and ever-increasing public expectations have resulted in reduced desirability to work in the field.
On a local level, the significant difficulties being faced by the NHS in Wales are off-putting to potential new recruits who can choose to work elsewhere in the UK or indeed abroad. Headlines relating to special measures at the Health Board, extreme waiting times, ambulance/A&E waits, relatively poor health outcomes, the threat of hospital downgrades, poor mental health services and struggling GP Out of Hours services all have a negative impact upon those who might otherwise seek to work here. With the advent of devolution, the ready flow of students and doctors from the North West of England to North Wales has been curtailed in favour of an all too familiar Cardiff-centric approach, yet this simply does not work as trainees in South Wales largely do not want to work in distant North Wales and vice versa. There is no medical school in North Wales. Separate registers (Performers’ Lists) for GPs in England and Wales create a bureaucratic barrier to the ease of movement of GPs from the nearby North West and an increasing divergence in NHS systems and consequent “fear of the unknown” is of concern to those who might otherwise look to this area to work. Anecdotal evidence suggests that potential GP recruits are also discouraged from locating themselves and their families in North Wales due to the perceived lack of excellent schools. All of these factors are compounded by a pay differential whereby I understand GPs in Wales stand to earn slightly less than those in England.
As the local Member of Parliament, I frustratingly have no direct control over health services (nor education) in Wales as these are managed by the Labour Welsh Assembly Government. I am however a member of the Westminster Health Select Committee and while the remit of this is essentially to oversee the NHS in England, many of the issues relating to GP recruitment are UK-wide. It is no coincidence that our first inquiry relates to primary care and I intend to ensure that workforce matters are dealt with in detail. Meanwhile, I will remain in close dialogue with the Health Board to exert influence where I can locally.
Queries about the future of Pendyffryn Medical Group should be addressed to firstname.lastname@example.org; Area Management Team – Central, Llandudno Hospital, Hospital Road, Llandudno, LL30 1LB; 01492 863378.