Health
Catheter care now closer to home thanks to innovative trial
HYWEL DDA University Health Board (UHB) is transforming the way it supports patients with urinary catheters across Carmarthenshire, Ceredigion and Pembrokeshire, thanks to a new Trial Without Catheter (TWOC) Improvement Project.
The scheme, launched in June 2024, shifts care from hospitals to the community, making it easier for patients to access timely treatment while reducing pressure on secondary care services.
A TWOC is a simple procedure to check if a patient can urinate naturally after an indwelling urinary catheter (IUC) is removed. If successful, it avoids the need for long-term catheter use, which can bring serious complications such as sepsis and catheter-associated urinary tract infections (UTIs). These account for around 75% of all UTIs and can also affect patients’ independence and quality of life.

Under the new model, every eligible patient is offered a TWOC within 28 days of catheter insertion. Community-based TWOC clinics are now running across all three counties, led by the health board’s award-winning ambulatory nursing teams. A dedicated triage nurse, funded for one year by Hywel Dda’s seven Primary Care Clusters, helped ensure patients were assessed and well-prepared before attending their clinic.
The results have been dramatic. Waiting times have fallen from 120 days to just 17 — an 86% improvement — and every referred patient has received a TWOC within the target timeframe. The success rate now stands at 62%, well above national and global averages.
The project has also delivered major financial savings, cutting over £98,000 in annual catheter-related costs, with a projected saving of nearly £500,000 over three years. It has freed up urology specialists to focus on urgent cases such as suspected bladder cancer referrals.



Emma Cottrell, Clinical Lead Nurse for Ambulatory Clinics, said: “The Trial Without Catheter Improvement Project has redefined how we deliver timely, effective care for patients with indwelling catheters. We have reduced waiting times, improved outcomes and eased the strain on hospital services.”
Patients and families have praised the service, with 100% of respondents saying they were satisfied with their experience, particularly the privacy, dignity and compassionate approach of staff.
One family member said: “The staff had lovely patience with my relative, which made the whole process go very smoothly.”
Another added: “The staff were fantastic with my aunt. Her dignity was respected at all times and the way they involved her was much appreciated.”
Jill Paterson, Director of Primary Care, Community and Long-Term Care at Hywel Dda UHB, said: “This project has transformed the patient experience. It’s a shining example of how innovation in community care can deliver real benefits for both patients and the wider health system.”
The TWOC Improvement Project supports the Welsh Government’s vision for healthcare — providing more care closer to home, preventing ill health and reducing health inequalities — while showing how integrated working between primary, community and secondary care can achieve measurable results.
Pictured at the top of the page:
Pembrokeshire TWOC Team- Front row from left: Catherine O’Sullivan, Sara Murphy, Julie White. Back row from left: Sarah Batty, Emma Cottrell
Health
Major investment confirmed for GP services in Wales
Government unveils £41m boost, but practices warn pressures remain acute
MORE than £41m in extra funding will go into general practice in Wales this year following a new agreement between the Welsh Government, NHS Wales and GP leaders. Ministers say the deal provides stability at a time of rising demand — but the settlement comes against a backdrop of sustained pressures, recruitment challenges and concerns over patient access.
The package includes a 4% uplift to the General Medical Services (GMS) contract for 2025-26, in line with independent DDRB pay recommendations, and a guaranteed 5.8% recurrent uplift from 2026-27. The Welsh Government says the multi-year commitment will allow practices to plan ahead, modernise systems and strengthen community-based services.
Health Secretary Jeremy Miles said the investment showed an “unwavering commitment” to general practice, adding: “The 4% pay uplift ensures fair recognition for GPs and practice staff who work tirelessly to deliver care for communities across our country. Multi-year funding gives practices the confidence to invest in the transformation primary care needs.”
However, the announcement comes at a time when many Welsh practices continue to report severe workforce pressures, rising demand, and longstanding challenges in recruiting new partners. GP numbers have fallen over the past decade, with some practices handing back contracts or operating list closures because of unsustainable workloads. Patient satisfaction with access has also declined, according to the latest Welsh GP Patient Survey.
What the deal includes
The settlement for 2025-26 comprises £37.9m of new investment and £4m in re-invested capacity funding, with the key elements including:
- A 1.77% uplift in expenses, intended to help practices manage inflationary pressures in energy, staffing and running costs.
- A recurrent £20m stabilisation fund to support practices facing immediate operational pressures and to prepare for wider reform under the incoming Sustainable Farming Scheme model for health.
- An increased partnership premium, aimed at retaining experienced GPs and encouraging new partners into a model that some say has become less attractive due to financial and regulatory risk.
- A full review of the GMS allocation formula — the first in more than 20 years — which determines how funding is distributed between practices. Some rural and deprived communities have long argued the current system does not reflect the complexity of local health needs.
Wider context
General practice remains the foundation of the NHS, accounting for around 90% of patient contacts, yet it receives a proportionally small share of the overall health budget compared with hospital services. Both the Welsh NHS Confederation and GPC Wales have repeatedly warned that without sustained investment, primary care risks being unable to meet increasing demand from ageing populations and rising chronic illness.
The Welsh Government’s own “community-by-design” programme relies on shifting more care closer to home, reducing pressure on emergency departments and supporting earlier intervention. For that to be achieved, GP leaders say investment needs to be matched with workforce expansion, improved digital systems, and clear strategies to retain experienced clinicians.
Working groups will now be set up to examine access standards, diabetes prevention and new service models.
Mr Miles said he was pleased that GPs would be “actively contributing to creating innovative care models that enhance access, improve outcomes and deliver care locally.”
GP representatives broadly welcomed the deal but have stressed that it is only one step in addressing the scale of challenge across primary care.
Health
Welsh NHS leaders hail GP contract deal as “vital step” in strengthening primary care
Agreement secures investment, digital upgrades and better patient pathways
WELSH NHS leaders have welcomed the successful conclusion of the new General Medical Services (GMS) contract for 2025-26 — and key elements of 2026-27 — describing it as a “positive example of social partnership” at a pivotal moment for general practice.
The deal, negotiated between Welsh Government, the Welsh NHS Confederation and GP representatives, sets out new investment and commitments for frontline primary care, including accelerated digital transformation through the NHS Wales App and strengthened support for population-level health management.
Darren Hughes, director of the Welsh NHS Confederation, said the agreement comes at a crucial time for GP services across Wales.
He said: “NHS leaders welcome this agreement as a positive example of social partnership in action. We also welcome the commitment to accelerating digital transformation for patients through the NHS Wales App and the measures agreed in the contract to enable enhanced population health management, such as diabetes management.”
Mr Hughes added that GPs and their multidisciplinary teams remain “the front door to the NHS,” and stressed that investment in general practice is essential if Wales is to treat more people closer to home.
“Evidence shows investing in primary and community care reduces demand on hospitals and emergency care and delivers returns of £14 for every £1 invested. To enable this shift ‘upstream’ from hospital-centred care to integrated services in the community, we must develop care pathways and joint performance measures that address the full needs of individuals,” he said.
Background: Why the GP contract matters
General practice forms the foundation of the Welsh NHS, handling millions of patient contacts every year. According to the latest official figures for 2023-24:
- Over 29 million calls were received by GP practices
- 18 million appointments took place
- 11 million of these were face-to-face
- More than 200,000 home visits were carried out
- 78 million prescriptions were dispensed
- Over 14,000 medication reviews took place
Demand has continued to rise while GP numbers have come under sustained pressure, particularly in rural areas such as Pembrokeshire, Ceredigion and Powys, where recruitment remains a long-running challenge. Practices in West Wales have repeatedly reported difficulties filling vacancies and increasing reliance on multidisciplinary teams, including nurse practitioners, pharmacists and physiotherapists.
The new GMS contract is therefore seen as a key mechanism for stabilising the sector, supporting digital access, improving chronic disease management, and helping to deliver the Welsh Government’s community-by-design programme, which aims to shift care away from hospitals and into community settings.
A recent survey by the Welsh NHS Confederation found that 74 per cent of NHS leaders support moving resources from acute hospital services into primary care, community-based services, mental health and social care, reflecting growing consensus around early intervention and prevention.
What comes next
The Welsh Government is expected to outline further detail in the coming months on how investment will be delivered at practice level, including support for digital tools, workforce development and shared performance measures with health boards.
With winter pressures mounting and hospitals facing record demand, NHS leaders say the success of the new GP contract will be central to improving access, reducing waiting times and ensuring patients in communities such as Pembrokeshire, Carmarthenshire and Ceredigion can receive timely, local care before conditions escalate.
The Welsh NHS Confederation represents all seven local health boards, the three NHS trusts, Health Education and Improvement Wales, and Digital Health and Care Wales.
Charity
Motorcycle fundraisers transform children’s play area at Glangwili Hospital
Long-running 3 Amigos and Dollies group marks 25 years of support
THANKS to outstanding fundraising by the Pembrokeshire-based 3 Amigos and Dollies Motorcycle Group, Hywel Dda Health Charities has funded a major improvement of the outdoor play area at Cilgerran children’s ward in Glangwili Hospital — a project costing more than £15,000.
The 3 Amigos and Dollies have supported Hywel Dda University Health Board’s children’s services for twenty-five years, with their Easter and Christmas toy runs becoming landmark dates in the local calendar, drawing hundreds of bikers and supporters from across west Wales.
The latest funding has delivered a full transformation of the ward’s outdoor space, including a re-sprayed graffiti wall, new toys and play equipment, a summer house, improved storage, and a moveable ramp to make the area more accessible for young patients. Members of the group even volunteered to help paint and refresh the space themselves.
Paula Goode, Service Director for Planned and Specialist Care, said: **“We are so grateful to the 3 Amigos and Dollies Motorcycle Group for their amazing support. Not only have they raised an incredible amount for the ward, but they have given their time to help make the outdoor space as special as possible.
“Outdoor play greatly reduces stress and anxiety for children, and it provides a vital opportunity to meet other young people going through similar experiences. It benefits both their physical and mental wellbeing, so we couldn’t be happier with the transformation.”
Tobi Evans, a volunteer with the fundraising group, said: “Because of the generosity of everyone who donates, we are able to give thousands each year. We are always humbled by how much people give, and it’s thanks to them that we’ve reached our 25th year.”
Katie Hancock, Fundraising Officer for Hywel Dda Health Charities, added: “We can’t thank the 3 Amigos and Dollies enough for their support for Cilgerran ward. You have put a smile on so many faces. Diolch yn fawr!”
Hywel Dda Health Charities funds items, equipment and activities that go beyond core NHS funding, making a meaningful difference to children and families across mid and west Wales.
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