Funding needs to ‘double’ while shifting care to GPs, Welsh Government told

The Welsh Government has been told shifting care to GP practices will not be possible without a period of doubling funding.

A ‘genuine shift of resources into primary care, not just a re-branding of existing resources’ is required with general practice the ‘enabler’ of this, according to a new report by the Welsh Parliament’s (Senedd) Health and Social Care Committee. 

The Future of General Practice in Wales also recommends formalising workload sharing between primary and secondary care; suggests measures to address the inverse care law; and introduce stricter standards for GPs to meet access requirements. 

The report, which calls on the ‘incoming Welsh Government’ to implement the changes, comes five weeks before national elections are to be held in Wales. 

On funding the planned ‘left shift’ from hospitals to the community, the report said: ‘A move to a more preventative agenda will require a shift in money and services, and will require a period of double funding to get there.  

‘This will need bold action from the incoming Welsh Government, which will need to make clear how funding and services will shift across from secondary care into the community, and over what period. There will need to be a well-planned transition for this, with a timeline, and a commitment to double funding for a period of time.’ 

On workload transfer, the report noted from evidence-gathering a ‘growing, often unacknowledged shift of responsibilities from secondary care to general practice’ including ‘initiating medications, managing hospital discharge follow-ups, and responding to NHS 111 calls, including those from the urgent mental health support line’. 

This has led to ‘a mismatch between responsibilities and resources, and raised ethical concerns about clinical safety and accountability’, it continued. 

The report recommended that health boards be required to ‘establish formal mechanisms to strengthen relationships and mutual understanding between primary and secondary care. 

‘This might include regular joint clinical forums, shared training opportunities, and agreed processes for resolving interface issues.’ 

A separate recommendation called for the incoming Government to ‘mandate the development of formal agreements between secondary and primary care’ to ‘ensure that funding and staffing “follow the patient” into primary care for each transferred service’.  

To address the ‘inverse care law’ – which states ‘the availability of good medical care tends to vary inversely with the need for it in the population served’ – the Government should financially incentivise GPs to work in ‘underserved communities’, which could include expanding existing schemes like the partnership premium payment. 

Solving this issue will also require reviewing the Carr-Hill funding formula in Wales, the report argues, recommending that the next Government produce a plan to do within 100 days of coming to power. 

This echoes the demand of Welsh LMC leaders who called for a ‘comprehensive’ review of the formula earlier this month. 

Deprived area general practice organisation Deep End Cymru commented: ‘We welcome the emphasis on shifting resources into General Practice, although we would have preferred this to be framed correctly as improving population health outcomes by shifting to more effective interventions. 

‘Reducing Inequalities in health outcomes is most effectively achieved through interventions in primary care rather than secondary care. So, the “shift left” is about saving lives and creating health, not just about taking pressure off hospitals.’

Finally, the committee urged the next Government to lay out a plan to ‘strengthen existing GP access standards and publish a clear plan for ensuring all practices meet them’, to ensure equal access for patients who form part of the ‘8am scramble’ because they cannot use digital systems. 

Dr Rowena Christmas, chair of RCGP Cymru Wales, said: ‘This inquiry has been a valuable opportunity to consider how people experience general practice and what practical steps the Government can take to support GPs to deliver meaningful continuity of care which works for our patients. It makes sense for the patient, the wider NHS and the taxpayer to invest in general practice.’

And Dr Gareth Oelmann, chair of the BMA’s Welsh GP committee, said: ‘BMA Cymru Wales valued the opportunity to share the challenges facing general practice in Wales with the committee, and we welcome the publication of the report. We look forward to engaging constructively with the incoming Welsh Government to secure the long term sustainability of general practice and to help deliver the shared aims of our Save Our Surgeries campaign.’