Welsh GP Practices at Risk of Collapse Amid Growing Patient Need

GP practices in some of the most deprived areas of Wales are facing severe challenges, with many at risk of collapse due to inadequate resources and overwhelming patient demand. This alarming situation was highlighted during a recent inquiry by the Senedd health committee, where evidence was presented by Adrian Edwards, a professor at Cardiff University.

On November 6, Prof Edwards, who retired in May 2023 after a long career in general practice, emphasized the critical issue of the “inverse care law.” This concept, introduced by Dr. Julian Tudor Hart in 1971, posits that the availability of quality medical care decreases as the need for it increases in the population. Prof Edwards pointed out that in Wales, areas with the greatest health needs often have the least access to adequate medical care.

The statistics paint a troubling picture. Currently, there are just 45 GPs for every 100,000 people in the UK, significantly lower than in countries such as Australia (121), Canada (103), and New Zealand (74). Wales ranks the lowest in the UK, exacerbating the challenges faced by healthcare providers in the region.

Rising Workloads and Declining Resources

Prof Edwards provided further insight into the growing strain on GP practices, noting a decline in the number of partners working in general practice over the past decade. He reported that the average number of patients per full-time GP has risen, with practices in affluent areas averaging 2,100 patients per doctor, while those in deprived areas serve around 2,400. Alarmingly, practices in poorer areas receive 7% less funding to manage these higher workloads.

The academic highlighted the alarming trend of GPs leaving the profession. In 2023, 10% of GPs under the age of 40 exited the workforce. Prof Edwards warned, “We’re haemorrhaging, we’ve got to do something about it immediately.” He noted that the overall number of GPs has remained stagnant since 1947, while funding for general practice has dropped from 11% to 7.6% of NHS spending in Wales over the last two decades.

The Human Cost of Inequality

The network Deep End Cymru, which focuses on improving healthcare in the most deprived regions, echoed these concerns. Jonny Currie, a GP partner at Ringland Surgery in Newport, explained that for every 10% increase in patients from impoverished backgrounds, practice income declines by an average of 1%. This disparity results in significant financial losses for general practices, despite the rising demand for services.

Dr. Neil James, chair of Deep End Cymru and a GP in the Rhymney Valley, described the situation as practices “collapsing” under the pressures of socioeconomic disadvantage. He emphasized the profound impact of societal disintegration on health in these areas, stating, “Inverse care has always affected us… the effects that has on patient health have been profound.”

Prof Edwards shared troubling statistics, revealing that 10% of GP practices in the poorest areas have either closed or merged in the past three years, while only 2.8% of practices in more affluent regions faced similar fates.

The evidence presented by Deep End Cymru highlights the stark divide in health outcomes based on socioeconomic status. Women in the most deprived communities spend an average of 16.9 years living in poor health, while men face a gap of 13.3 years.

As the inquiry continues, the health committee faces critical questions regarding how to address these disparities and support the beleaguered GP practices serving Wales’s most vulnerable populations. The urgent need for reform in funding and resource allocation has never been more apparent, as healthcare providers struggle to meet the needs of those they serve.