Scrapping GP catchment areas – superficially attractive but not essentially practical

Good to hear that this isn’t a priority for the Welsh Assembly Government as the BMA can see many drawbacks to the idea of scrapping GP catchment areas.

For a start, the rest of the health service and social services and county councils all work by boundary areas, and so to just suddenly take general practice out of that system, would be terribly complicated and actually very difficult to make work.

It would be hard for patients to access a doctor in more rural areas - how would they get home visits when they are ill, if they are registered miles away, near their place of employment?

Also what would happen to practices that are destabilised because some of the younger, healthier patients have gone elsewhere? Surgeries with a mix of patients, where some don’t visit their doctor that often, help general practice to be cost-effective. If younger people register near their workplaces, some practices could be left with patient lists mainly composed of those with long-term conditions and complex illnesses, severely disadvantaging some practices.

We do support boundaries being a little more flexible, so long as practice organisation isn't interfered with. We also support practices trying to make it as easy as they can for patients to see their regular doctor whenever possible. Our main concern though is not to disadvantage the most vulnerable, which these changes could possibly lead to.

So for the Department of Health to argue that the main reason for scrapping GP surgery boundaries is to increase patient choice, is in essence a false one, with many surgeries perhaps having to close as a result of these changes. This seems to be change for the sake of it.

Posted on behalf of Dr David Bailey, Chair of GPC Wales.

Swine flu vaccine agreement reached for Wales

Agreement for a swine flu vaccination programme to be rolled out by GPs across Wales, I am pleased to say, has been reached.

General practice is an efficient and adaptable model that reaches into every community in Wales and is best placed to deliver the vaccination. GPs are used to delivering large scale vaccination programmes that target patients at highest risk and this agreement means that GPs and their teams will have the resources they need to take on the additional workload and run the vaccination programme smoothly and efficiently.

This agreement is testament to the cooperative work we have produced with the Welsh Assembly Government and our GP members look forward to delivering the protection for vulnerable groups that the people of Wales deserve.

A ban on violent patients doesn’t seem so "understanding"

And just to add to my earlier blog post on violence and aggression, whilst we support the memorandum of understanding, we wouldn’t go as far as calling for people who are violent towards NHS workers to be banned from using frontline services, which is what Barbara Wilding, the Chief Constable of South Wales police seems to be advocating. A tougher approach is needed, we definitely agree with that, but to try and prevent people from accessing NHS services would be a potential violation of their human rights and goes against the very ethos of the NHS – health services accessible to all. Better surely that we focus on the points made in my earlier blog than to be so draconian?

More than just understanding is needed to tackle violence and aggression in the Welsh NHS

This development is a step in the right direction and should help with the investigation and prosecution of alleged attacks against doctors and the wider medical profession.

Action to show people that violent behaviour will not be tolerated is long overdue with the problem becoming more widespread. More than 7,000 incidents were reported in the NHS in 2007-08. It is also an area that we have been calling for action for several years now, having been made aware of many incidents where our members have been victims of violence and aggression. As far as BMA Cymru Wales is concerned, it is totally unacceptable and inexcusable to attack a doctor, or any healthcare professional in the line of duty, when they are trying to ensure the good health and well being of patients.

There is still much to be done in completely stamping out this problem, which, to many of our members is sadly becoming part of the norm of their daily working lives.

To stand alongside this memorandum of understanding, BMA Cymru Wales is calling for the following;

• A register of violent patients - If a doctor, nurse or other healthcare personnel can be alerted in advance to the possibility of a patient becoming violent, s/he will be forewarned and no longer placed in a position of vulnerability, through a lack of relevant information.

• Training and Communication - Ensure that all staff are fully trained and are aware of the mechanisms to report physical or verbal abuse and that they are encouraged to report incidents.

• Staff Support - Ensure that all staff are supported at all times, and continuing support (counselling services for example) are available after the violent incident.

• Public Awareness - Patients and healthcare users need to know that they are not outside of the law while in contact with healthcare professionals and that those offenders will be brought to justice.

If these measures are brought in to force as well, then we really could be well on the way to eradicating this, unfortunately, growing issue.

The WAG could be storing up a whole heap of problems over a lack of GPs

It seems as if nothing has changed yet then in terms of the future of the GP workforce in Wales, or if it has, it’s only a change for the worse. The latest round of “Workforce Statistics for General Practitioners in Wales, 1998 – 2008” just serve to highlight how much of a ticking time bomb Wales is sitting on when it comes to having enough GPs to serve the population. Put simply, the figures show how those GPs coming up to retirement age aren’t being replaced by younger doctors. I blogged on this particular issue earlier this year and so these stats just back up everything I said then.

There are several reasons as to why Wales may soon be facing a GP shortage, a key one being demographics, with lots of older, single-handed GPs coming up to retirement age in the valleys. Also in Wales, GP incomes are lower than their counterparts in England, but with a higher workload than England. There may also be less opportunity for surgery partnerships in Wales. Then of course, there has been the trend over recent years (and rightly so) for an increased emphasis on work/life balance, making it easier for more GPs to work part-time.

And just as there is no one reason, there probably isn’t one easy solution to what could be a very serious issue in the coming years. The reorganisation of the Welsh NHS is due to really come into effect over the next few weeks, which sees a greater emphasis on the role of GPs and primary care, so it really is about time that the Government here starts taking the recruitment and planning of the Welsh GP workforce seriously. Otherwise, as the old classic song goes "There may be trouble ahead..."