Over the last few weeks, I have spent time visiting our GP practices and community pharmacies across the Ogmore constituency. I’ve spoken with the receptionists (note: they are far more than the title gives them credit!), Practice Managers, consultants and GPs, independent prescribers in pharmacies, practice nurses and allied professionals and more.
So, what were my big takeaways from these visits and in-depth discussions?
Lesson One: those who work in primary care deserve our full respect and support.
The GPS and pharmacists I know and their staff (ask a receptionist whether all they do is answer calls!) go above and beyond their roles and contracts. They take their mission for our well-being really seriously.
I’ve seen heroic and selfless acts, with Practice Managers and support staff supporting & signposting vulnerable people in debt and financial despair, not just responding to the physical and mental health challenges. I’ve seen amazing pharmacists and GPs working well beyond the hours which are sensible for their own well-being: to make sure that their patients are seen safely; completing essential administration: attending (unpaid) meetings with Health Boards and clusters or colleagues to explore the next great innovation they will do together to improve the lives of some of the most health-disadvantaged communities in Wales.
Sometimes they get things wrong, as we all do. They all provide slightly different services, and they perform slightly differently too. This should not be a surprise as much of the primary care sector – from doctors to dentists to pharmacists to optometry – operate as independent businesses whilst providing publicly-funded NHS services. They often operate nowadays in “clusters” to share best practise and innovation. But each GP practice and community pharmacy will still operate independently and slightly differently.
The differences can frustrate residents who sometimes vent their concerns on social media or write to their Senedd members. Some have been tempted to “have a go” at the receptionists or front-desk staff. That is simply not acceptable. If you have a problem, start by having a calm and reasonable discussion with the receptionist, and if not resolved go upwards to the manager.
There can be understandable frustrations: delays in responses or appointments, delays in treatment, delays in medications … fill in your own frustration in the gap. Often the problems are not of the surgery or the pharmacy’s making. But – and I say this as a patient too – we all have a responsibility to raise any concerns respectfully. We are all human. And we never know what else is going on behind the scenes.
Our local community pharmacists and GPs and other primary care providers truly believe in their mission to tackle health inequalities and improve our lives. Indeed, Welsh Government has spent the last decade and more trying to help them, lining-up public-funding to do just this. But the financial strains are now telling, for some obvious reasons which I will go into below.
But this brings me to the next takeaway from my visits.
Lesson Two: The Primary Care Sector is under huge pressure, whilst trying to do more.
We are constantly asking our primary care providers to do more for us. There are good reasons for this. If we can fully utilise the skills and capacity of GPs and community pharmacies and other primary care providers closer to our homes and in our communities to keep us all well for longer, then we can reduce pressures “upstream” in the higher-cost and higher-dependency parts of the NHS like the hospitals and secondary care.
So more and more of the best of our community pharmacies are now independently diagnosing and prescribing treatments for a range of minor ailments and conditions, working closely with local GPs, and taking some of the load off those GPs too.
Similarly, our GPs are no longer just the place you see your doctor. They are the base for dieticians and practice nurses, asthma and diabetes specialists, cervical screening, management of long-term conditions and much, much more.
Yet at the same time as trying to do more, the financial pressures bearing down on primary care are the same as those across the wider NHS and health and care sector (and indeed across local authorities and public services entirely).
They face the same rises in energy bills and other unavoidable inflationary costs that all businesses do. They also have to cope with the uplifts to the Real Living Wage (bear in mind that some staff will be on this wage or not much more).
So, I understand the logic of current campaigns to ask for more public funding for GP practices or other parts of primary care. There is a real case to be made to government. But that brings me to the next key point
Lesson Three: wider public funding is also under extreme pressure
For over a decade, public services in England and Wales have been dealing with the cumulative impacts of austerity. This has been a political choice of the UK government. Add to this the disastrous impact of the Truss budget from last year, inflationary costs which also hit the public purse, and there is a £1.3bn black hole in the Welsh budget to fund all public services.
I repeat: a £1.3bn black hole, thanks hugely to policies and politics pursued over 13 years by the Westminster Government. That’s out of a roughly £20bn budget for all Wales spend, so you have a clear idea of the major impact this real terms cut has on spending in Wales.
That in turn means that we now have public-funding under extreme pressure in every aspect that affects our lives: local government; health and social care; homelessness and affordable housing; public transport; farming support and environmental schemes … I could go on, but it is all quite bleak. We must hope that it won’t always be this way, but right now, there is no silver lining.
Against this context of the worst financial settlement facing Wales in its whole period of devolution, every sector affected by cuts – and that is pretty much every sector – is crying out in pain. All of these sectors make our lives better, and more bearable in times of difficulty or distress. But no sector is immune to the current UK-wide predicament which has been forced upon us.
So, I agree with the case being made by primary care for more support. I also see the need to invest in social care (from wages and conditions of care workers to greater recruitment and training and state-of-the-art care homes); in homelessness support (austerity starves investment from front-line charities which help people find homes and support for example); in new and better sustainable farming and environmental schemes (we have seen the promised “not a penny less” totally betrayed by UK governments thanks to a botched Brexit); and so much more besides.
Yet all areas of our society which we depend on for our well-being, and which depend on public support, are now facing a Westminster imposed foot-on-the-windpipe of investment.
Conclusion: Constructive collaboration and “social partnership” is now more important than ever.
Over the last decade and more of dire financial settlements from the UK government – which has not changed as we speak – we have managed to work our way through by working more closely together across publicly-funded services. This is what we have called the “social partnership” approach. We need to draw on this even more under the current pressures.
With our GPs and across primary care (as with other sectors reliant on public-funding to any extent) under intense pressure, and public funds squeezed also, the only way we will get through this to brighter days is by working together in a spirit of frankness and openness.
The BMA have a very effective campaign underway called Save our Surgeries. It has some good points which are worthy of proper debate and discussion. I will be calling on Ministers to engage with the BMA on this, even if there may not be immediate or easy answers. Equally, I will call on the BMA to recognise the constraints on the current finances in Wales, and to factor this into the way forward.
At the time, contracts negotiations between the BMA and Welsh Government have broken down. The BMA’s GP Committee argue that the offer by the Health Minister Eluned Morgan of a ‘5% GP pay award’ and a ‘5% staff pay uplift’ was inadequate to redress the pressures of the last decade. I will be pressing the Minister and the BMA, regardless of the impasse on those negotiations, to return to wider discussions to explore a collaborative way forward – partnership for the years ahead – but in the context of the current and foreseeable budgets.
Every sector which is wholly or partially reliant on public funds (taxpayer funds) is now under the most intense pressure. Public services and health and care are desperately trying to make the cake go further. But – at this moment – there is no more cake! Giving more of the cake to someone who really needs it, means taking more of the cake from someone else who is equally deserving. This is the hard reality of the here and now under this UK government.
But my final point is this. Going forward, we need to find a way to invest in primary care properly for the reasons I laid out at the beginning: if we invest in keeping you and me well for longer, we save money from the more expensive costs of repairing us when we arrive in A&E or secondary care. The solution to that is not just finding more and ever more funding. The solution is also using the funding we currently put into health and care better, more effectively and efficiently, so the money goes to the right places, and goes further in delivering good health and well-being outcomes.
As we mark the 75th anniversary of the NHS, we should have that frank discussion on how we better use the £11bn we currently spend on health in Wales. That should be part of the solution too.