GP PRACTICES serving the most deprived parts of Wales are under-resourced, overworked and facing collapse despite experiencing the greatest patient need, a committee heard.

Adrian Edwards, a professor at Cardiff University, gave evidence to a Senedd health committee inquiry on the future of general practice today (November 6).

Prof Edwards, who retired from practice in May, reminded Senedd members of the inverse care law – a term coined by Julian Tudor Hart, a GP in Glyncorrwg, Afan valley, in 1971.

It states the availability of good medical care tends to vary inversely with the need for it in the population served, so those who need health care most often have the least access.

Prof Edwards warned the UK is lagging behind other countries, with 45 GPs per 100,000 population compared with Australia (121), Canada (103) and New Zealand (74). He added that Wales was bottom of the UK table, according to latest statistics.

The academic, who was a GP partner for 25 years at a practice which handed back its NHS contract in 2020, said the number of partners has declined every year for a decade.

He told the committee the number of patients per full-time GP has increased in that time, with the total number of consultations also rising since 2019.

Prof Edwards said: “What we also have is an inverse workload law. In the affluent areas of Wales, the average number of patients per GP is 2,100 and in deprived areas it’s 2,400. And, by the way, those practices get 7% less income to provide those services.”

He explained doctors in the poorest areas have more patients to start with, who present about twice as often as those in more affluent areas.

Prof Edwards said the number of GPs has been largely flat since 1947, with resources being funnelled into hospitals “trying to do cure and not doing prevention”. He said the proportion of NHS spending on general practice in Wales has fallen from 11% to 7.6% over 20 years.

He cautioned that focusing on reform of the Carr-Hill formula used to allocate funding to GPs is a zero-sum game: “If you help someone, you’re taking away from someone else.”

Prof Edwards said 10% of GPs aged under 40 left the workforce in 2023, warning: “We’re haemorrhaging, we’ve got to do something about it immediately.”

Deep End Cymru, a network of GPs working to improve care in the most deprived areas, warned practices in less well off parts of Wales are “quietly drowning”.

Jonny Currie, a GP partner at Ringland surgery in Newport, said for every 10% increase in patients from the poorest areas – practice income falls by an average of 1%.

Dr Currie, policy lead at Deep End Cymru, told Senedd members: “We’re looking at tens of thousands less money coming into general practice,” despite greater demand.

Neil James, chair of Deep End Cymru and a GP partner in the Rhymney valley, added: “What we have seen is practices collapsing, going to the wall in many of these areas.”

Dr James, a GP for 22 years who is from Senghenydd, told the committee: “Inverse care has always affected us… having lived and worked in the valleys… you’ve seen societal disintegration and the effects that has on patient health has been profound.”

He pointed to a lack of training practices in poorer areas as a key problem, with GPs so busy at the coalface that they lack capacity. He said his practice faces ‘wall-to-wall deprivation”.

Prof Edwards raised statistics showing 10% of practices in the poorest areas closed or merged, compared with 2.8% elsewhere, over the past three years.

Deep End Cymru’s evidence laid bare the human cost of such inequalities.

The network of 91 GP practices warned women in the most deprived communities spend an average of 16.9 more years living in poor health. For men, the gap is 13.3 years.

ALARMING health warnings that microplastics are being found in human brains, blood and breastmilk sparked calls for a ban on single-use plastic on fresh fruit and vegetables.

Rhys ab Owen, who sits as an independent, brought forward a cross-party proposal to ban the use of “unnecessary” single-use plastic packaging for fruit and veg.

He told the Senedd: “Plastic packaging makes no difference whatsoever to the shelf life of over 20 fruits and vegetables… Simply put, plastic packaging, very often, is entirely wasteful, unnecessary and purposeless. We don’t need that packaging at all.”

Raising a 61% increase in food banks in Wales, Mr ab Owen pointed to research showing plastic packaging contributes to £2.1bn-worth of food waste in the UK every year.

Calling for fruit and veg to be sold in paper bags, he said food is becoming unaffordable for many and being able to buy smaller, rather than predetermined, amounts could help.

Mr ab Owen also warned of serious health risks, telling Senedd Members: “When plastic breaks down into microplastics, it’s then absorbed into the human body and has now been found in all organs of the body, including our brains.”

He pointed to a study last year by the New England Journal of Medicine which identified increased risks of heart attack, stroke or death when micro or nano plastics were found.

The former barrister warned: “Despite this, the use of plastic continues to grow and has grown dramatically over the past few decades.”

Labour’s Jenny Rathbone raised a Cardiff University study at the Dŵr Cymru treatment plant in Newport which found significant levels of plastics in wastewater. She said treated water is spread on agricultural land, bringing plastics back into the whole food production system.

Ms Rathbone recommended not to drink water from plastic bottles, saying it can add around six times more microplastics into your system compared with tap water.

Janet Finch-Saunders, the Conservatives’ shadow environment secretary, said she had “no hesitation whatsoever” when Mr ab Owen asked for her party’s support.

She told the Senedd: “We cannot forget that microplastic pollution has been detected in human blood, with scientists finding the tiny particles in almost 80% of people tested.

“The more we can do to reduce this unnecessary plastic use the better. A ban on the use of single-use plastic… for fruits and vegetables would be a step in the right direction.”

Labour’s Carolyn Thomas raised evidence from the Wrap Cymru charity which shows only 19% of fresh produce is sold loose compared with 50% in mainland Europe.

She said: “France has already gone further, passing legislation to ban plastic packaging on fresh produce altogether. If France can do it, why not Wales?”

Delyth Jewell, Plaid Cymru’s shadow environment secretary, described the proposed ban as a “no-brainer” and something young people feel passionately about.

“This is something that we have to guard against for their sake,” she said. “It’s something very young children feel passionately about as well because of how quite viscerally frightening it will be for them. It is so important that we change this.”

Huw Irranca-Davies, Wales’ Deputy First Minister, pointed to the Environmental Protection Act 2023, which has restricted often-littered products such as straws, cutlery and cotton buds.

But Mr Irranca-Davies cautioned of potential unintended consequences of extending restrictions to single-use packaging for fruit and veg.

“There is a ‘however’ in this,” he said. “There are several important aspects that we need to explore further before we consider bringing forward legislation.”

Mr ab Owen responded:  “I’m very used to the Deputy First Minister’s – and other Welsh ministers’  – ‘howevers’. I’m used to, ‘Oh, I agree with the sentiment, however, we need to check this. We need to do other research, another commission’, or whatever…

“I think we need bolder governance here in Wales, where people are willing to make decisions, where they don’t wait and wait and wait until they know 100% that this is the right thing. Sometimes, we just need to get on and do it.”

AMBITIOUS new plans to make NHS Wales greener, more efficient and fit for the future have been unveiled during Wales Climate Week.

The updated NHS Wales Decarbonisation Strategic Delivery Plan sets out how the health service will accelerate its journey towards the legally binding Net Zero 2050 target, with a focus on reducing emissions, improving energy efficiency and promoting sustainable healthcare practices.

NHS organisations in Wales have already made significant progress, cutting emissions from buildings, transport and other non-supply chain sources by almost 25% between 2018-19 and 2024. However, overall emissions have risen slightly during the same period due to the large carbon footprint associated with NHS Wales’ extensive supply chain.

The refreshed plan aims to help NHS Wales organisations:

• Increase energy efficiency and use more renewable energy sources
• Support sustainable travel for staff and patients
• Work with suppliers to minimise environmental impact
• Reduce waste and improve recycling
• Embed sustainability into all areas of healthcare delivery

The Cabinet Secretary for Health and Social Care, Jeremy Miles, said: “We are striving for a more sustainable health system, which will reduce its impact on the environment and provide wider benefits to public health.

“We all have a part to play in addressing the climate emergency. The NHS in Wales can make a real difference by reducing waste, saving energy and working sustainably, while continuing to deliver high-quality care.

“Improving the sustainability and environmental impact of NHS Wales will help Wales meet its Net Zero commitments by 2050.”

Pioneering projects leading the way

Across Wales, health boards are already leading the charge through innovative sustainability projects.

At Cardiff and Vale University Health Board, the award-winning Green ICU Team has spearheaded a number of schemes that have improved patient care while cutting costs and reducing waste.

Over the past five years, the team has cut plastic waste in intensive care units by around two tonnes per year, saving tens of thousands of pounds. Their “Gloves Off” campaign, which encourages staff to reduce unnecessary use of non-sterile gloves, is on track to save £15,000 and around 490,000 gloves this year alone – equivalent to about 30 gloves per patient per day in critical care.

Other successful initiatives include recycling patient feeding bottles, offering tap water instead of sterile water, and installing energy-efficient LED lighting across wards.

Consultant in adult intensive care medicine Dr Jack Parry-Jones, who led several of these projects, said: “We are trying to preserve a world – a Wales – worth surviving for and living in. Our mantra is people, planet and profit.

“People – providing excellent care for our patients and staff. Planet – maintaining a clean environment and protecting biodiversity. Profit – delivering value-based, prudent healthcare.”

The new strategy underscores the Welsh Government’s wider goal of ensuring every public service plays its part in tackling the climate emergency and building a healthier, more sustainable Wales.