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GP shortage in Wales: Patients per doctor double European average

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THE NUMBER of patients per GP in Wales is over twice the European average, raising concerns about primary care availability for hundreds of thousands of patients across the country.

In 2024, a report by BMA Cymru Wales showed that the European average for patients per GP was around 1,000. In Wales, the average is 2,210 patients per full-time GP. Over the last decade, the average number of patients per practice has increased by just under 25%.

RURAL ISSUES

Over the past decade, the number of GP practices in Wales has decreased by 18%, dropping from 470 to 378. This decline is due to a combination of closures and mergers, reflecting broader challenges in general practice, such as workforce shortages and increasing patient demand.

The situation is worsened by the fact that around 80% of Wales’s land area is relatively sparsely populated, consisting of small settlements grouped around former market towns. New GPs are overwhelmingly concentrated in Wales’s few larger urban centres, chiefly along the M4 corridor and the North East Wales border area.

This means rural patients often have to travel significantly longer distances to access GP services compared to urban residents. The closure of rural practices forces patients to register with larger, more distant surgeries, increasing the patient-to-GP ratio. This results in longer waiting times and reduced appointment availability.

Long travel times and a lack of transport deter individuals from seeking timely care, leading to delays in diagnosis and treatment. By the time patients present for clinical care, their conditions may have worsened, making treatment more expensive and reducing the likelihood of positive clinical outcomes.

And that is before patients are placed on one of the NHS’s lengthy waiting lists for diagnosis and treatment.

The older age profile of Wales’s rural GPs was long recognised as a ticking time bomb under primary care. Yet, efforts to stem the outflow of GPs from rural Wales have been patchy and ineffective. Changes to pension rules have accelerated retirements, and as older rural GPs leave the profession, replacing them has become increasingly difficult.

The reasons are clear. Rural Wales faces huge difficulties attracting and retaining GPs due to professional isolation, fewer career development opportunities, and a lack of interest in rural practice partnerships. These factors have led to a reliance on locum doctors or salaried GPs, which in turn can disrupt continuity of care.

IN PEMBROKESHIRE

Practice closures and the shortage of GPs have hit Pembrokeshire hard.

The Argyle Medical Group in Pembroke Dock is the second-largest GP practice in Wales, with around 25,000 patients registered and just nine GPs—an average of 2,800 patients per GP. In 2021, the practice had 10.75 full-time equivalent GPs and was seeking to recruit more. However, due to a lack of available GPs, the practice was forced to withdraw from its Neyland practice at St Clement’s Surgery and reduce hours at St Oswald’s Surgery in Pembroke.

Argyle Medical in Pembroke Dock has the second-largest GP practice in Wales

As a knock-on effect of the Neyland closure, patients were transferred to the Neyland and Johnston Medical Practice, which eventually handed back its GP contract following retirements and recruitment difficulties. Its patients are now serviced by salaried and locum GPs employed by the Health Board.

The same issues have plagued GP practices from Tenby in Pembrokeshire’s southeast to St Davids in the northwest. While it would be a stretch to say that “GP deserts” exist in the same way as “NHS dental deserts,” the increasing patient load on hospitals suggests that many people are now seeking treatment at A&E for conditions that would previously have been managed by a GP.

The Welsh Government’s approach is to ask patients to self-triage before going to hospital—an impractical and, for many, heartless solution. If you are a parent with a child in agony and unable to tell you what is wrong, what would you do?

SITUATION NORMAL, SITUATION CRITICAL

In 2018, the Welsh Government announced a plan to recruit 1,000 GPs into NHS general practice in Wales. While the number of GPs has increased, it has not risen by anything close to 1,000. Worse still, the number of full-time GPs has actually fallen.

What this means is that while there are technically more GPs in total, there are fewer available in practice because many of the new recruits work part-time, as locums, or on limited contracts (for example, as doctors on call).

It’s the same statistical sleight of hand used to describe frontline clinical staff in the Welsh NHS. Welsh Government ministers proudly claim that the Welsh NHS employs more people than ever, yet the number of full-time staff has plummeted.

In an attempt to address the GP shortage, the Welsh Government has increased the number of routine clinical assessments and treatments that pharmacists and practice nurses can undertake. However, only seven relatively minor ailments can be treated by pharmacists independently, while practice nurses must have GP approval to prescribe medication.

Expanding community-based healthcare is a sensible aim, but it is undermined by the critical shortage of full-time GPs in rural Wales. There are not enough independent prescribing pharmacists or community nurses to fill the gap. The reliance on locum GPs disrupts continuity of care, leading to situations where patients are taken off long-term medication without explanation or, worse, experiencing increased risks of missed or misdiagnosed conditions.

Wales has reached a tipping point.

Politicians frequently offer warm words about “our NHS,” “our precious NHS,” and “our wonderful NHS nurses and doctors,” but none have publicly acknowledged that the foundation of NHS care—GP surgeries as the first point of contact for the sick—has buckled. If they did, they would have to come up with real solutions instead of blaming patients for being ill or making vague promises about digital medicine transforming rural healthcare.

The situation is critical.

In Wales, that passes for normal..

 

Crime

Milford Haven drug dealing pub boss who boasted of ‘best coke around’ jailed

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Dealer who claimed £160,000 profits was later calling police for protection as threats escalated over money he owed to his suppliers

A MILFORD HAVEN drug dealer who bragged he had “the best coke out there” and claimed to have made up to £160,000 in just four months has been jailed for six years.

But behind the image of a confident, high-earning operator, the reality was starkly different — a man in debt, under threat, and repeatedly calling police for protection as his world closed in.

Police at Marble Hall Road, Milford Haven in 2025, protecting Dan Booth from drug dealers who threatened to kill him (Pic : Herald)

The 35-year-old defendant admitted multiple offences relating to the supply of cocaine and cannabis when he appeared before Swansea Crown Court.

The court heard he played a significant role in the supply of Class A and Class B drugs, purchasing large quantities — including claims he was buying cocaine by the kilogram — and maintaining contact with upstream suppliers.

In messages shown to the court, he boasted about his profits, claiming to have made £38,000 and suggesting that far larger sums were within reach. He also claimed to have earned £160,000 in just four months and said he had bought two houses.

He told customers he had “the best coke out there” and responded aggressively to complaints, stating: “Out of £30,000 worth, you’re the only one to complain,” before adding: “Bad mouthing me is a bad idea you little slag.”

The Vibe pub in Milford Haven is now closed following Dan Booth being jailed for six years

Violence and intimidation

The court was also shown chilling footage of a confrontation at a property on the Mount Estate, where the defendant was heard directing violence over a debt.

In the video, he shouted: “I got boys, yeah, I got boys,” before telling others to “kick his head in” as the attack unfolded inside the victim’s home.

Witnesses described him as having become a “kingpin” in Milford Haven’s drug scene, operating from The Vibe public house, which they claimed was used as both a legitimate business front and a base linked to drug dealing.

Fear behind the façade

Yet the court heard that behind the bravado, the defendant was living in fear.

He had accumulated drug debts estimated at between £18,000 and £26,000 and was being threatened by those higher up the supply chain. His partner reported people turning up at their home, with threats including claims it would be bombed or burned down.

The Herald attended his home address on multiple occasions to report on police activity after he called officers for protection.

In a direct call to this newspaper during the period, he said: “There are threats to my life — people want me dead, dead. I don’t want this in the paper. It’s over money… hundreds of thousands of pounds.”

Documents reveal further pressure

The Herald can also reveal that the defendant was served with a statutory demand in late 2025 over an alleged unpaid debt relating to stock, fixtures and fittings following his takeover of The Vibe public house in March 2024.

Documents seen by this newspaper indicate the financial pressures he was under extended beyond drug debts.

National attention

The case has already drawn national interest, with Channel 4 making a documentary featuring the defendant after interviewing local people in Milford Haven over recent months.

‘Significant role’ in drug trade

Police arrested the defendant on January 5 last year on suspicion of being concerned in the supply of Class A drugs. A search of an address on Priory Road uncovered 18 grams of cannabis, while a separate incident involving a vehicle led to the discovery of 73 grams of cocaine and cannabis.

Prosecutors said he was actively involved in the supply of drugs and purchasing large quantities, describing him as a key player in the local trade.

He has 57 previous convictions, mostly for theft-related offences.

‘Only a custodial sentence’

Defending, Mr Ibrihim described his client’s background as a “tale of woe,” telling the court his father was addicted to heroin and his mother struggled with alcohol. His younger sister died in 2022.

The court heard he had gone “off the rails” in his late teens and that his drug dealing was linked to debts, including those connected to his father. It was also said that many of his claims about wealth were exaggerated and amounted to “bravado”.

Sentencing, the judge said: “The seriousness of this offending means that only an immediate custodial sentence is appropriate.

“You played a significant role in drug dealing. What is clear is that you were dealing with a lot of cocaine.

“I have no doubt that some of what you did was due to pressure, but some of it was for your own gain.”

The judge added that despite the defendant’s claims of wealth, “you haven’t got hardly anything left”.

For the supply of cocaine, he was sentenced to six years in prison, with a concurrent sentence of 30 months for supplying cannabis.

He will serve at least half the sentence in custody before being eligible for release.

A victim surcharge of £228 was also imposed.

 

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Community

Loose horse sparks police response in Pembroke

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Animal seen galloping through residential streets and towards main road

POLICE are reportedly tracking a loose horse which strayed into a residential area of Pembroke.

The animal was first spotted in Gatehouse View before making its way onto a nearby main road.

A post on the Pembroke and Pembroke Dock Citizens’ Forum said the horse had left Gatehouse View and was seen heading towards the road by Pembroke Leisure Centre.

The resident wrote: “Anyone recognise it? Police following it.”

The horse was later reported to be galloping down Buttermilk Lane in the direction of Martha’s.

Stray horses are not uncommon in the area. In January, several animals were reported loose around Pembroke and along the A477, particularly near Buttermilk Close and the Cleddau Bridge.

Those incidents created a hazard for motorists, prompting Pembrokeshire County Council to step in and return the animals. Drivers were advised to take extra care and avoid startling them.

 

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international news

Britain exposed: UK has no real shield against long-range Iranian missile threat

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Reliance on US interceptors leaves gaps as Iran’s reach grows

BRITAIN would struggle to defend itself against a long-range ballistic missile attack and would instead rely heavily on American systems based in Eastern Europe and at sea — with no guarantee of success.

That is the stark reality emerging after Iran’s attempted strike on a UK–US base at Diego Garcia on Saturday (March 21), a move that caught many world leaders off guard and marked a significant escalation in capability.

Defence analysts say that its possible for Iran to hit targets of up to 4000 miles away

Concerns are further heightened by Iran’s development of larger space launch vehicles, including the Simorgh, Zuljanah, Ghaem-100 and Qased systems, which on paper demonstrate ranges of between 2,200 km and up to 6,000 km, with payload capacities of up to 1,000 kg. While these rockets are officially designed to place satellites into orbit rather than deliver warheads, they use the same multi-stage technology and propulsion systems found in long-range ballistic missiles. Defence analysts have long warned that such programmes provide a clear pathway to intercontinental strike capability, raising the prospect that parts of Europe — and potentially even the UK — could fall within reach if these technologies are adapted for military use.

No UK shield over Britain

The UK has no dedicated system to shoot down long-range ballistic missiles over its own territory.

While RAF Fylingdales provides early warning and tracking, it cannot intercept incoming threats. Britain’s air defence network — including RAF jets and ground systems — is designed for aircraft, drones and cruise missiles, not high-speed ballistic weapons.

In simple terms, if a missile were heading toward a target such as Milford Haven’s energy facilities, there is no British-operated system that could reliably stop it at the last moment.

America would have to act

Instead, any interception attempt would fall to the United States.

Key assets include:

  • Aegis Ashore missile defence bases in Romania and Poland
  • US Navy warships equipped with SM-3 interceptors
  • Wider NATO tracking and coordination systems

These systems are capable of striking a missile in space during its midcourse phase, long before it reaches the UK.

But there is a crucial limitation: they can only engage if the missile passes within range of those systems.

If the trajectory falls outside that envelope — or if no US ship is positioned correctly — there may be no interception at all.

A probability, not protection

Even when an intercept is attempted, success is far from certain.

Testing data for the SM-3 system suggests success rates of roughly 50 to 80 per cent per engagement, depending on conditions. In practice, multiple interceptors are often fired at a single target to improve the odds.

That still leaves a significant margin for failure.

In a real-world scenario involving countermeasures, technical faults or multiple missiles, the chances of at least one getting through rise sharply.

Gaps in coverage

The NATO missile defence network is not a continuous shield.

It is a patchwork of coverage zones tied to specific systems:

  • Romania and Poland provide fixed land-based interception capability
  • US warships offer flexible but limited coverage depending on deployment

There is no permanent protective umbrella over the UK itself.

If a missile does not pass through one of those defended zones, Britain would effectively be relying on luck and geometry.

Deterrence, not defence

Ultimately, the UK’s primary protection is not interception — it is deterrence.

Any successful strike on British soil would almost certainly trigger a major NATO response, making such an attack extraordinarily risky for any adversary.

But deterrence does not equal defence.

A growing concern

Iran’s attempted long-range strike on Diego Garcia has shifted the debate sharply.

The use of a missile capable of travelling thousands of kilometres surprised many Western leaders, who had not expected Tehran to demonstrate that level of reach in the current crisis. Although one missile failed and another was intercepted, the incident has raised fresh questions about how far Iran’s capabilities have advanced.

For years, the idea of a missile threat to Europe — let alone Britain — was largely theoretical. Now, defence analysts are treating it as a credible future risk, even if capability remains limited today.

The bottom line

The UK can detect a missile, track it, and coordinate a response — but when it comes to actually stopping it, the country would be dependent on American systems operating at distance, with no certainty of success.

If a missile ever did get through, there would be little standing between it and its target.

And that is the uncomfortable truth behind the headlines.

 

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