The fact Wrexham is suffering a GP shortage, like many other areas, is unsurprising but this neck of the woods is afflicted by issues particular to North Wales.
Two practices shut their doors within a year up to last June, with another taken over by Betsi Cadwaladr University Health Board, and difficulties getting appointments are increasing exponentially. One in seven patients in the region are under the control of the health board.
Set that picture against 13 practices that closed across Wales since October 2015 and it puts the local GP crisis in context.
Another closure is planned in Gresford, a leafy suburb 15 minutes from central Wrexham with a population of 5,000, where Alyn Family Doctors recently announced an application to transfer services to its centres at Rossett and Llay, both a little over two miles away. These centres already work with 3,200 and 4,800 patients respectively.
The consultation on that proposal has now ended but a public meeting on May 10 highlighted the frustration of patients, with around 300 packing the village’s Memorial Hall to vent their anger.
’Many GPs are discouraged from working in Wales by the registration process’
Dr Sara Bodey, a partner at Bradley’s Practice in nearby Mold, is chair of the North Wales local medical committee and says the LMC has been warning of recruitment problems in the region for years.
’The problem is UK-wide but worse in North Wales partly because we are far away from universities. It doesn’t make sense to just have links with the Cardiff deanery,’ she said.
’There’s lots of good work going on in Cardiff but we need to be realistic about the geography of North Wales.
’The north-east, where I am, is geographically very close to Liverpool and Manchester,’ she added.
It makes as much sense to build bridges with deaneries in the north-west of England as Cardiff, although Dr Bodey concedes work being done in Cardiff will help the southernmost areas of North Wales.
Betsi Cadwaladr UHB now manages 15 surgeries – six more than in 2017 – across North Wales. In the past two years there have been the two closures (both in Wrexham) and six others are under threat, potentially affecting well in excess of 14,000 patients, according to BMA data.
Seventy-four Welsh GP surgeries are either at risk of closing or being handed back to health boards according to the BMA’s latest figures. But why can’t an increasingly large number cope?
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One explanation is thought to be the beauty of Wales and its attractiveness to retirees – it has an over-65 population that is 2.5% greater than the UK average.
That age group brings with it panoply of concomitant health risks and morbidities that GPs must manage.
Another factor is regulations requiring practitioners from other parts of the UK to be accredited through the Medical Performers List.
This adds at least six weeks to recruitment which puts off applicants, according to the chief officer of North Wales Community Health Council, Geoff Ryall-Harvey.
‘It’s a ludicrous situation and one easily solved. North Wales Community Health Council is seeing the consequences of the difficulties in recruiting GPs,’ he said.
‘There is a large pool of potential recruits on the Welsh/English borders but many are discouraged from working in Wales, in part, by the registration process.
‘Taking the example of a GP living in Chester who might be choosing between locum posts in Blacon (England) and Saltney (Wales) – both about 2,000 yards from the centre of Chester. Such a GP is likely to choose the Blacon job rather than go through a further bureaucratic form-filling exercise,’ added Mr Ryall-Harvey.
The problem is worse in North Wales partly because we are far away from universities
Dr Sara Bodey
The fact the accreditation lapses if a practitioner has not worked in Wales for 12 months is another hurdle.
LMC chair Dr Bodey added: ’Ideally we would like to work with a UK-wide Performers’ List, although I do think there will be a resolution to this problem in the short term.’
A recent options paper published by the Welsh Government suggests, after years of lobbying, the Performer’s List situation may be resolved soon.
Betsi Cadwaladr UHB now has more than 86,000 patients – 14% – out of a North Walian population of around 630,000, under its direct control. But with the health board being in deficit – and in special measures for three years come this June – change is well overdue.