GP leaders attending this year’s Welsh LMCs conference all voted in favour of having more ‘meaningful support’ for practices at risk of closure.
Proposed by North Wales LMC, the motion said that ‘the current sustainability process is not fit for purpose’, and that support from local health boards (LHBs) for practices at risk of closure is ‘at best inadequate and at worst non-existent’.
The motion was passed unanimously at the conference, which took place in Lladudno last Saturday, and will become official policy for BMA Wales’s General Practice Committee (GPC). Delegates have called for the committee to:
- Work with the Welsh Government and LHBs to reform the sustainability process and make it both simpler and more responsive;
- Mandate the provision of a meaningful support package from LHBs if a practice is found to be at high risk of collapse.
Proposing the motion, Dr Jennifer Liddell from North Wales LMC said that her practice had been at risk of collapse, which lead to a ‘lengthy’ assessment that required ‘large amounts of evidence’ and ‘general meetings’. However, this assessment did not for example consider ‘local bills’.
Dr Liddell said that the assessment made the LHB look as if it was ‘determined to refuse to help’.
She said: ‘We did in the end get some temporary support, but this amounted to a sticking plaster.
‘More recently, locally, several practices have raised concerns that they are at risk of collapse.
‘If nothing is done to help practices at this very difficult time, we will be seeing the further collapse of many GMS practices.’
She added: ‘I call on GPC Wales to work with the Welsh Government and health boards to make the process simpler and quicker, and to update the provision of a meaningful support package from the local health boards.’
In response, BMA GPC Wales said it supported both parts of the motion. A spokesperson said: ‘Of course, sustainability is actually contractual and acts as commitment.
‘We need to be proactive and spend to save in the long term, and the process definitely needs tweaking. We press conference to support both parts of the motion.’
Motions were also passed to provide financial support to practices in line with rising inflation in order to mitigate the effects of the cost-of-living crisis.
And the Welsh Government was asked to review the funding formula ‘for multisite and small rural practices to prevent further practice failures, in the spirit of the original Carr-Hill formula’.
However the conference voted against a motion which had proposed that Wales moves to a item-of-service fee GP contract similar to that used in Australia.
Choice motions in full
Conference believes that the current sustainability process is not fit for purpose, and that the support from Local Health Boards (LHBs) for practices at risk is at best inadequate and at worst non-existent. We call on GPCW to:
i. work with Welsh Government and LHBs to reform the process and make it both simpler and more responsive.
ii. mandate the provision of a meaningful support package from LHBs if a practice is found to be at high risk of collapse.
Rising building costs are putting practices at risk of financial collapse. Conference calls on GPC
Wales to task Welsh Government to:
i. Put sufficient short term financial support (above the current contract agreement) in place to avoid contract hand-backs.
ii. Work in the medium term to de-risk the premises element of general practice along the lines of the Scottish model.
Passed, part 2 taken as a reference
That Conference urges Welsh Government and NHS Wales to review funding formulae for multisite and small rural practices to prevent further practice failures, in the spirit of the original Carr-Hill formula.
Conference requests Welsh Government to provide financial support to practices in line with rising inflation for the purpose of sustainability and stability
That Conference calls on Welsh Government to develop a short, medium and long-term workforce strategy, in conjunction with other relevant partner agencies, and to ensure that contract negotiations acknowledge the reduced capacity, accepting that ‘Business as Usual’ is no longer an option.
Most GPs in Wales are regularly consulting at levels in excess of the 35 patient contacts a day recognised as the threshold for ‘unsafe’ workload by the BMA. Conference calls on GPC Wales to ensure that practical and effective steps are taken within the contract negotiations to bring consulting rates within safe limits for the sake of patients, clinicians and the sustainability of General Practice
Conference believes that improved continuity of relationship-based care should be encouraged in preference to access targets.
Conference demands that Welsh Government and Health Boards take action to ensure the timely provision of Ambulance services for patients, and not expect GPs to provide urgent and emergency care until the ambulance reaches the patient.
Education and training
Conference is disappointed in Welsh Government’s unilateral removal of the universal training incentive scheme and calls on them to reinstate the payment of the first Applied Knowledge Test (AKT) and Clinical Skills Assessment fee for all trainees in Wales.
Conference advises Welsh Government that the incentives to encourage GP registrars to choose GP vocational training schemes in Mid, West and North Wales have had a positive effect, and request that it is continued to build a sustainable GP workforce in
Conference asks NHS Wales to measure the carbon footprint of a sample of Welsh GP Practices in order to better understand the steps needed to deliver net-zero carbon Healthcare.
The half day and lunch time closing changes within the 2022-23 contract put a disproportionate strain on small practices. Conference asks GPC Wales to ensure that reciprocal cover arrangements are recognised in subsequent contractual agreements
Conference recognises that LHBs were guilty of a contractual breach by not providing cover to facilitate practice protected learning time in the previous contractual year. We call on GPCW to ensure that in the future full cover will be mandated from LHBs for all protected learning sessions.
Conference despairs at the thought of continuing to flog the dead horse that is our capitation-based GMS contract, and we rejuvenate our call for GPC Wales to negotiate an activity-based model.
Conference urges GPC Wales to negotiate an IOS fee based unified GMS contract similar to that in place in Australia.
Conference observes that despite political desires, Clusters are not delivering improved services, Accelerated Clusters are not deemed fit for purpose and these should be scrapped, and resources transferred to core General Practice.
Conference directs GPC Wales to instruct the Welsh Audit Office to examine the value for money obtained when managed practices are run by LHBs within Wales.