'Crisis' GP service 'on its knees', senior doctor claims

Family doctors in Wales face a "crisis" and enormous pressures mean the profession is "on its knees", one of Wales' most senior GPs has warned.

Dr Charlotte Jones said rising demand coupled with a shrinking workforce meant GPs were often "too exhausted" to see patients out of hours.

The chair of the British Medical Association's GP Committee in Wales said Wales faced a GP "brain-drain".

The Welsh government said it recognised GPs faced increased daily pressures.

In an interview with BBC Wales, Dr Jones spoke about reports of doctors leaving general practice, and increasing numbers taking early retirement.

"The profession is under such enormous strain that GPs are feeling the pressure physically and mentally dealing with just their daytime job," she said.

"We love our jobs and went into it to do general practice but the demands and complexity mean we can't keep working at that pace."

The pressures, she suggested, were Wales-wide but Dr Jones insisted problems with recruitment and retention meant they were more acute in rural areas.

The BMA has also raised concerns that the high costs of additional insurance which GPs needed to take out to see patients out of hours could be a disincentive to doctors undertaking such work.

"There are concerns about the sustainability and stability of out of hours. We do not have enough doctors in our opinion to do the work, and with changes to insurance fees doctors have to pay, there are going to be less and less," said Dr Jones.

"We are hearing about unfilled shifts in north Wales and some rural areas and that causes us enormous concerns.

"We hear suggestions - why not use other healthcare professionals? Let's not be silly, let's not think that anybody can replace a skilled GP."

But Dr Jones dismisses claims that GPs are contributing to pressures on A&E departments by not doing enough to keep patients that do not need to be in hospitals out of them.

Earlier, giving evidence to the assembly's public accounts committee, the BMA argued that GPs saw around six million emergency consultations each year compared to around 200,000 A&E consultations which could be judged unnecessary.

'Local surgery'

"We do hear that [the claim GPs contribute to A&E pressure] and it really rankles within the workforce," said Dr Jones.

"We know if we had more services available in the community, if we had more staff, we might well be able to keep patients out of hospital.

"But at the end of the day some people need hospital appointments and no GP is going to deny that."

But Dr Jones does admit more could be done to make it easier for patients to be seen at their local surgery.

"I'm not going to defend the indefensible, we do need to constantly look at how we're delivering services to patients. But practices are under such strain I don't think they have time to do that at the moment," she said.

Dr Jones said the Welsh government needed to increase the funding allocated to general practice, which she claimed had decreased as a proportion of the NHS budget for several years.

She also said there should be greater effort to recruit and retain family doctors.

'Negotiations'

Another solution she proposes would be to change the Welsh GP contract to reduce "unnecessary bureaucracy" and allow doctors to concentrate on the "art of general practice".

The BMA is currently negotiating with the Welsh government elements of the latest Welsh GP contract, which sets out the roles and responsibilities of general practitioners.

It is hoped the details can be finalised before the end of the year.

But Dr Jones praised the Welsh government's approach to the negotiations.

"Compared to England we have a very good working relationship with the Welsh government, who listen to our concerns," she said.

Dr Jones was elected chair of the BMA's Welsh GP Committee in July. She is the first woman to hold the post.

A Welsh government spokesperson said: "We recognise that GPs, along with other healthcare professionals across Wales, are facing increased daily pressures.

"We are in discussions with GPC Wales (the BMA GP committee in Wales) to address some of their concerns.

"As part of the proposed changes to the GP contract for 2014/15, we are looking at how the Quality and Outcomes Framework can be altered to reduce bureaucracy, eliminate unnecessary patient testing, and eliminate unnecessary frequency of patient recall and recording.

"This, we believe, will allow GPs to spend more time on the most vulnerable patients."