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Health

Reversing GP funding crisis like turning a supertanker, doctors warn

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THE WELSH Government must be courageous and shift money from the “bottomless pit” of hospitals to reverse relative defunding of GP surgeries, doctors told a Senedd inquiry.

Gareth Oelmann, chair of the British Medical Association (BMA) Cymru’s GP committee, criticised a decline of funding for general practice as a whole over many years.

Dr Oelmann, a GP partner in Cwmbran, said the proportion of NHS Wales spending dedicated to general practice has fallen from 8.7% to 6.01% since 2005/06.

He told the Senedd’s health committee: “That decline… has come at the detriment of practice viability, sustainability, and you’ll have seen the figures within the last ten years of how 100 practices have returned their contracts.”

The BMA is calling for the proportion of the NHS Wales budget spent in general practice to be restored to 8.7% within three years, which would require an investment of £292m.

Ian Harris, deputy chair of the BMA committee
Ian Harris, deputy chair of the BMA committee

Ian Harris, a GP partner in Bridgend who is deputy chair of the BMA committee, said GPs can be part of the solution to pressures on hospital services.

“But, certainly, we can’t do more with less,” he stressed. “And, over the years, we’ve been asked to do more and more and more with a reduced proportion of the NHS spend.”

Rowena Christmas, chair of the Royal College of General Practitioners (RCGP) Cymru, warned GPs are firefighting all the time due to reducing budgets.

She said: “We’ve only got one pot of money and we need to be courageous with it and take it away from the bottomless pit of the hospital and put a little bit more towards primary care.”

Rowena Christmas, chair of RCGP Cymru
Rowena Christmas, chair of RCGP Cymru

In its written evidence, the Royal College of GPs highlighted research showing that every £1 spent on general practice saves £3 of hospital costs.

Pressed on why health boards do not accept the need to reverse the decline in GP funding, Dr Oelmann warned of a blindspot due to lack of primary care voices around the table.

Dr Harris added that it is also a policy decision at Welsh Government level to focus on the shiny bits of the health service such as hospitals and waiting lists.

“That needs to change and we’re making that argument,” he said while giving evidence to an inquiry on the future of general practice on September 17.

“But it’s like trying to turn around a supertanker because the direction of travel… has been to relatively defund general practice and primary care in favour of other sectors.”

Dr Oelmann emphasised the need to look at the overall pot as well as reform of the Carr-Hill formula which was designed in the 1990s to distribute funding to practices.

Dr Harris echoed concerns about the clamour surrounding the “outdated” Carr-Hill formula, with a focus needed on total funding to avoid “moving around the deckchairs on the Titanic”.

The panel raised concerns about uncertainty arising from prolonged contract negotiations, with Dr Harris saying: “You’re always on the backfoot and we’re always working in arrears.”

Tom Kneale, a GP in Denbighshire
Tom Kneale, a GP in Denbighshire

Tom Kneale, a GP in Ruthin, Denbighshire, added: “It’s exceptionally difficult… to predict what services I can provide within my practice if I don’t know what funding’s coming in.

“We don’t know whether we can replace our boiler, we don’t know if we can afford another salaried GP. This is an exceptionally difficult circumstance to work in day in, day out.”

Dr Oelmann warned of the human cost of the GP funding crisis and the attritional nature of the job – with the workforce decreasing while the workload increases.

More than 80% of GPs feel patient safety is being compromised by excessive workloads and 37% are ‘unlikely’ to still be working in general practice in five years, an RCGP survey found.

Dr Harris said Wales is about 700 GPs short but practices cannot afford to employ available trainees  – some of whom are subsequently deported because they do not have a sponsor.

He suggested the Welsh Government’s “Train Work Live” campaign to attract healthcare professionals to Wales might be better titled “Train Work Leave”.

Health

Fresh alarm over life expectancy in Wales as CMO warns of ‘prevention revolution’

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WALES is living sicker for longer, the Chief Medical Officer has warned, as new figures show a worrying drop in the number of years people can expect to live in good health – with women hit hardest.

The findings, published today in Dr Joanne Absolom’s first annual report since taking over from Sir Frank Atherton, have prompted immediate calls for the next Welsh Government to overhaul its approach to public health after the 2026 Senedd election.

Dr Absolom says Wales must now move decisively away from a system that largely treats illness towards one that prevents people becoming ill in the first place. Her report warns that healthy life expectancy is falling across the country and highlights widening inequalities between communities.

Responding to the findings, Darren Hughes, Director of the Welsh NHS Confederation, said the message could not be clearer.

“NHS leaders in Wales welcome the report’s call for a prevention-first approach,” he said. “We have to move from simply treating illness to actively promoting wellbeing, and that means a proper cross-government strategy that tackles inequality and gives people the support to take control of their own health.”

He added that every pound spent on proven public health programmes delivers an average return of £14 – evidence, he said, that prevention “makes moral and financial sense” at a time when NHS budgets are under extreme pressure.

“It is deeply concerning to see healthy life expectancy falling, particularly for women,” he said. “Investment in prevention is vital if we are to make our health and care services sustainable.”

While health boards, councils and community groups are already working on preventative programmes, the Welsh NHS Confederation says Wales needs far greater ambition – and the NHS must be given the tools and flexibility to scale up what works.

The Chief Medical Officer’s report also raises serious concerns about NHS workforce shortages and urges significant investment in digital technology to improve productivity and patient outcomes.

Mr Hughes said all political parties should “take heed” as they prepare their manifestos for next year’s Senedd election.

“Those seeking to form the next Welsh Government have a clear blueprint here. We cannot keep doing the same things and expect different results. Prevention, workforce and digital transformation have to be top priorities.”

The Welsh NHS Confederation — which represents all seven health boards, the three NHS trusts, HEIW and Digital Health and Care Wales — has already outlined its detailed priorities in its own election document, Building the health and wellbeing of the nation.

With the Senedd election just over a year away, today’s report adds fresh, authoritative evidence that Wales needs a radical shift in how it approaches health if it is to secure a healthier future for all.

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Health

Government orders clinical review amid sharp rise in mental health diagnoses

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4.4 million working-age people now claiming sickness or incapacity benefit, up by 1.2 million since 2019, many because of a mental health condition

A CLINICAL review into how mental health conditions are diagnosed across the UK is expected to begin this week, following concerns within government over rapidly rising sickness-benefit claims linked to conditions such as autism, ADHD and anxiety.

Health Secretary Wes Streeting has commissioned leading clinical experts to examine whether ordinary emotional distress is being “over-pathologised” and to assess why the number of people receiving sickness and incapacity benefits has grown to 4.4 million – an increase of 1.2 million since 2019.

According to reports in The Times, ministers are particularly alarmed by the surge in the number of 16- to 34-year-olds now out of work because of long-term mental health conditions.

Streeting said he recognised “from personal experience how devastating it can be for people who face poor mental health, have ADHD or autism and can’t get a diagnosis or the right support,” but added that he had also heard from clinicians who say diagnoses are “sharply rising”.

“We must look at this through a strictly clinical lens to get an evidence-based understanding of what we know, what we don’t know, and what these patterns tell us about our mental health system, autism and ADHD services,” he told the newspaper. “That’s the only way we can ensure everyone gets timely access to accurate diagnosis and effective support.”

The review is expected to be chaired by Prof Peter Fonagy, a clinical psychologist at University College London specialising in child mental health, with Sir Simon Wessely, former president of the Royal College of Psychiatrists, acting as vice-chair.

Prof Fonagy said the panel would “examine the evidence with care – from research, from people with lived experience and from clinicians working at the frontline of mental health, autism and ADHD services – to understand, in a grounded way, what is driving rising demand.”

The move comes as the UK Government faces mounting pressure over the rising welfare bill. Ministers earlier this year pulled back from proposed changes to disability benefits, including those affecting people with mental health conditions, after opposition from Labour backbenchers.

Speaking on Monday, the Prime Minister said a fresh round of welfare reform was needed.

Keir Starmer said: “We’ve got to transform it; we also have to confront the reality that our welfare state is trapping people, not just in poverty, but out of work.”

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Health

NHS Trust CEO ‘forced out’ after raising concerns — Welsh Govt denies wrongdoing

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A CONSERVATIVE MS has pressed the Welsh Government for answers after the sudden departure of the Velindre University NHS Trust’s chief executive, amid media reports that he raised concerns about alleged governance failures within NHS Wales Shared Services.

During Health Questions in the Senedd today, James Evans MS asked Health Secretary Jeremy Miles to explain why former CEO David Donegan left his post after just a year. Reports circulating in recent weeks suggest Mr Donegan had raised issues relating to governance, and in some accounts, possible criminality. These claims have not been substantiated publicly.

Velindre’s own 2024/25 annual report notes that the Trust “escalated concerns to Audit Wales and Welsh Government about the current governance of Shared Services, which hadn’t been reviewed since 2012.” No details of the concerns have been published.

Welsh Government response

Jeremy Miles MS confirmed in the chamber that correspondence relating to the issues does exist, but said it would not be appropriate to release sensitive material while internal processes are ongoing. He did not comment on the circumstances of Mr Donegan’s departure, citing employment confidentiality rules which are standard across the NHS and public sector.

A Welsh Government spokesperson has previously said that they expect all NHS bodies to follow “proper governance and HR procedures,” and that they “do not comment on individual employment matters.”

Velindre NHS Trust position

Velindre has not publicly stated that Mr Donegan was removed because of whistleblowing activity. The Trust has described his departure simply as a “change in leadership” and says it continues to engage with Audit Wales and the Welsh Government on governance matters.

Opposition criticism

After the exchange, James Evans MS — the Welsh Conservative Shadow Cabinet Secretary for Health — criticised the Health Secretary’s “lack of transparency”.

He said:

“I am extremely disappointed with the Health Secretary’s refusal to provide clarity on the circumstances surrounding Mr Donegan’s departure, or to release the correspondence relating to governance concerns within Shared Services. The public must be able to trust that millions of pounds of NHS funds are being managed properly.”

Mr Evans said he will write to the First Minister and Cabinet Secretary formally requesting the publication of correspondence “in the interests of full accountability.”

Context: What is NHS Shared Services?

The NHS Wales Shared Services Partnership (NWSSP) manages national procurement, payroll, recruitment, estates services and other core functions for health boards and trusts. It sits within Velindre University NHS Trust but operates independently of its operational healthcare work. Governance arrangements for NWSSP were originally set a decade ago and are subject to periodic review by Audit Wales.

There is no evidence at present of wrongdoing by the Welsh Government or NWSSP, beyond the concerns referenced in Velindre’s annual report.

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