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Health

WG and BMA clash on GP standards

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AS THE growing crisis in West Wales’ GP services continues, the Welsh Government last week announced a new set of standards, which it claims will raise and improve the level of service for patients.

Recent National Survey results showed a decline in satisfaction with GP services from 90% being satisfied in 2016-17 to 86% in 2017-18 and 42% of participants found it difficult to make an appointment at their practice an increase from 38% in the previous year.

The Welsh Government says that ‘people in Wales should know what to expect when they need advice on their health and wellbeing, when they need to consult a GP or other healthcare professional and what other options are available to them’.

To support the above, the new standards are as follows:
• People receive a prompt response to their contact with a GP practice via telephone.
• Practices have the appropriate telephony systems in place to support the needs of people avoiding the need to call back multiple times and will check that they are handling calls in this way.
• People receive bilingual information on local and emergency services when contacting a practice.
• People are able to access information on how to get help and advice.
• People receive the right care at the right time in a joined-up way which is based on their needs.
• People can use a range of options to contact their GP practice.
• People are able to email a practice to request a non-urgent consultation or a callback.

The Welsh Government expects all GP practices in Wales, supported by their Local Health Boards, to meet these standards by March 2021. Financial support, which will be announced in due course, will be made available to GP practices to strive towards meeting these standards and ensuring patients across Wales know what to expect from their practice.

Vaughan Gething said: “I know GPs and their practice teams are under pressure to meet demand but I also know people’s expectations on GP access are not currently being met.

“Today’s announcement is not about putting additional pressure on our GP services, it is about them delivering a level of service patients in Wales should expect as a minimum. For many practices across Wales, the standards I’ve announced today will already be in place, but for others, this will be a journey of improvement. Over time I would like to see these standards developed further so that services are continually improving for the citizens of Wales.”

Responding to the Welsh Government’s announcement Dr Charlotte Jones, chair of the BMA’s Welsh GPs’ committee said: “GPs in Wales work extremely hard – often to the detriment of their own health – to ensure that patients are seen in a timely manner and this is reflected in the still very high satisfaction ratings.

“Whilst we accept, welcome and strive for better access for patients recognising the challenges patients face, the way to address this is to support GP practices to release capacity for patients who need their care. This can be achieved through improving recruitment of GPs, practice nurses and ensuring the wider multi-disciplinary primary and community care workforce are in place. It can be achieved through ensuring patients are empowered to self-care when appropriate. It can be achieved through resourcing supporting infrastructure for practices to take forward different ways of providing access; through properly supporting practices and enhancing the partnership model so that we have sustainable services available to patients.

“Imposing standards on an already overstretched workforce is not the best way to achieve the shared aim of improving access.

“We will continue to work with the Welsh Government to ensure that patients are seen in a way that is most suitable and appropriate for their need. This work needs to also include robust support for practices so that they have the resources they need to address the challenges they face on a day to day basis, where they are fire-fighting to meet ever increasing demand and thus enable them to have the capacity to develop their access arrangements for patients.”

Health

MP launches survey to tackle GP access issues

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MID AND SOUTH PEMBROKESHIRE MP Henry Tufnell has launched a survey to address growing concerns about access to healthcare and GP services in the county.

The survey aims to gather feedback from residents, which will be presented to the Health Board in the new year.

Mr Tufnell told The Herald: “I urge constituents to complete my survey and share their experiences with healthcare and GP access. I have been meeting with local GP practices and Health Board executives to discuss the challenges facing our community.

“Each response will be taken forward to the Health Board. My aim is to ensure patients’ concerns are heard, leading to better services for everyone. Pembrokeshire deserves and needs improved healthcare outcomes.”

The survey is live on the MP’s website and can also be accessed via his social media channels.

Survey link: Click here to participate

Contact details:
Joshua Beynon, 07802 761520, [email protected]

Henry Tufnell is the MP for Mid and South Pembrokeshire.

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Health

New NHS data shows the same old problems

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ALTHOUGH the latest batch of NHS performance data contained some good news for the Welsh government, chronic problems with meeting targets remain the headline.

The Welsh Government announced further funding to reduce waiting lists earlier this week. Following that announcement, the Health Minister, Jeremy Miles, led a Welsh Parliament debate on waiting times on Tuesday, November 19.

HARD FIGURES

The number of patient pathways increased from 800,163 in August to 801,307 in September, the highest figure on record, equivalent to one-quarter of the Welsh population.

There were still around 618,200 individual patients waiting for treatment in September.

Two-year waits remain at 23,701 in Wales. Eluned Morgan promised to eliminate these waits by March 2023 and again by March this year. The dial is moving slowly in the right direction, but progress is painfully small.

At the end of September, the average (median) time patient pathways had been waiting for treatment was 22.7 weeks.

In October, only 50.4% of red calls (the most serious) received an emergency/ambulance response within eight minutes. This is a tiny improvement but a long way short of the Welsh Government’s performance target for the Welsh Ambulance Service. The Ambulance Service has never hit any of its performance targets since the Welsh Government first set them.

Performance worsened against the 62-day target for patients starting cancer treatment; it is now 55% as of September.

MINISTER FINDS THE POSITIVES

Wales’s Health Minister, Jeremy Miles, responded to the data: “I’m pleased to see the number of patient pathways waiting more than a year and two years for treatment have fallen in the last month.

“This shows positive progress is being made across Wales to reduce the longest waiting times. I hope to see this continue.

“While there has been a small rise in the overall number of patient pathways waiting to start treatment, more than half are waiting less than 26 weeks, and there was a fall in the number waiting more than 36 weeks in September.

“We recognise the impact long waits for treatment can have on someone’s life, both mentally and physically, so we have a laser-like focus on reducing the longest waits and improving access to patient care.

“More than 1,800 people started cancer treatment in September, and nearly 14,000 people received the good news they didn’t have cancer.

“There were also reductions in the long waits for both diagnostics and therapies services and some reductions in the numbers of pathway of care delays.

“Urgent and emergency care services continue to be under great pressure – in October, the Welsh Ambulance Service received the second highest number and proportion of immediately life-threatening calls per day on record, but more than half of these calls received a response within eight minutes.”

NHS “AT CRISIS POINT”

Sam Rowlands MS, Welsh Conservative Shadow Health Minister, said: “I fear that we are at a crisis point as waiting list figures continue to head in the wrong direction in Labour-run Wales.

“The Labour Health Minister’s latest initiatives, even if his expectations are met, will barely scratch the surface in terms of tackling these excessive, record-breaking waits for treatment. Something needs to change fast.

“The Welsh Conservatives will stand up for the Welsh people’s priorities by eliminating restrictive guidance blocking cross-border and cross-sector working and by enacting a substantial workforce plan to boost staffing numbers, with a tuition fee refund for healthcare workers at its heart.”

LOCAL TRENDS

The month-to-month performance data provide a limited snapshot of the details. Their nature encourages politicians to exchange barbs and engage in self-praise. Specious comparisons between Welsh NHS performance and English NHS performance crumble under the gentlest scrutiny, not least as the English NHS counts waiting times and collates patient data differently from the Welsh.

Long-term trends are more revealing.

Immediately before the Covid pandemic (data released in March 2020), 1.6% of patients in the Hywel Dda UHB area waited over 36 weeks from referral to treatment. 85.7% of patients went from referral to treatment within 26 weeks.

By March 2022, 35.2% of patients in the local health board area were waiting for more than 36 weeks, and the percentage seen within 26 weeks had fallen to 56.7%. By the following March, just over 60% were seen within 26 weeks, and the proportion of patients waiting more than 36 weeks had fallen to 28.2%.

If you move forward to September 2024, Hywel Dda UHB’s performance figures have marginally slipped. There are no peaks and troughs in the performance data; they remain steadily bumping along at the same level and are far worse than they were in March 2020.

The Health Minister’s honest acknowledgement that the £50m funding injection to address waiting times is a short-term measure to boost performance and not a long-term solution highlights the scale of the problem. The question of waiting lists is not how much money it will take to tackle them but how much money will be spent before radical reform tackles systemic problems with healthcare delivery.

Placing Hywel Dda’s difficulties in a national perspective, the Welsh Government’s planned care recovery plan established a target to eliminate two-year waits in most specialities by March 2023. ‘Most’ refers to all specialities, excluding seven recognised as exceptionally challenging even prior to the pandemic.

Those specialisms, which include Orthopaedics, ENT, and Gynaecology, are large areas of surgical practice. They are excluded from targeted improvements because tackling them is too difficult. Proposals to establish surgical hubs made by the Welsh Conservatives have not attracted Welsh Government support as resources and staffing remain highly problematic. However, a quick win for the Welsh Government on the longest waiting times is potentially available.

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Charity

‘Grave concerns’ over national insurance hike

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SENEDD Members expressed grave concerns about the impact of the UK Government’s national insurance tax hike on GPs, universities and charities in Wales.

Plaid Cymru leader Rhun ap Iorwerth warned the rise in employer national insurance contributions from 13.8% to 15% in April will have a disproportionate impact in Wales.

He told the Senedd: “Labour are quick to accuse others of fantasy economics whilst their own plans represent nightmare economics for thousands of employers and employees.”

Raising concerns about the impact on job creation and wages, he said employment levels are at their lowest for almost a decade – lower than anywhere else in the UK.

He accused Labour of breaking a manifesto pledge as he pointed to an Office for Budgetary Responsibility (OBR) assessment that three quarters of the cost will be passed to workers.

Leading a debate on November 20, Mr ap Iorwerth called on the UK Treasury to fully cover the added cost to public sector employers in Wales.

He said: “It’s not the private sector only … bearing the brunt. Charities, GPs, universities – sectors already feeling the squeeze, to say the very least – have been taken to the brink.”

He pointed to “eye-watering” bills of £90,000 for some GPs, with the British Medical Association warning some surgeries could close as a consequence.

Mr ap Iorwerth said mental health charity Plattform faces a £250,000 annual bill and Welsh universities, “already crippled by financial challenges”, will face significant further pressures.

Plaid Cymru’s motion urged Welsh ministers to press the UK Government to apply a wider definition of the public sector workforce to include universities, GPs and charities.

Peter Fox, the Conservatives’ shadow finance secretary, similarly accused Labour of breaking a manifesto commitment not to raise tax on working people.

The former council leader said: “Time and time again – the chancellor went on TV and made the claim, only to u-turn after they got into power.”

Mr Fox, who represents Monmouth, said even a 1% rise in employer national insurance contributions for the public sector would cost Welsh taxpayers an extra £100m.

He told the Senedd: “The UK Government has said that it will provide funding to cover the cost of national insurance contributions for those workers.

“However, this will still come out of the taxpayer’s pocket … ultimately it is the taxpayers who are going to pay for the Chancellor’s tax increase.”

Luke Fletcher, Plaid Cymru’s shadow economy secretary, warned the national insurance rise will be a drag on an “already anaemic” Welsh jobs market.

His colleague Sioned Williams, who also represents South Wales West, described the chancellor’s “back-of-a-fag-packet” plans as senseless.

She raised concerns about six-figure increases in tax bills for charities including Tenovus, Marie Curie, Citizens Advice Cymru and the Wastesavers Charitable Trust.

Cefin Campbell, Plaid’ Cymru’s shadow education secretary, said the national insurance increase will cost Welsh universities an estimated extra £20m a year.

The Mid and West Wales MS warned: “Without a shadow of a doubt, these additional costs could push our higher education institutions over the precipice.”

Labour’s Hefin David said difficult decisions had to be made to fill a £22bn “black hole” left by the Tories but he rejected Plaid Cymru claims of a return to austerity.

Dr David told the Senedd: “Yes, tough decisions have to be made but I think that in the longer term, this is to everyone’s benefit.”

Andrew RT Davies, leader of the Conservative opposition, disputed the “incorrect” £22bn figure, saying the OBR found a £9bn gap.

Replying to the debate, Mark Drakeford stressed that neither he nor the Welsh Government has responsibility for national insurance contributions.

Wales’ finance secretary, who was appointed in September, criticised “fantasy economics” from opposition members on the Plaid Cymru and Conservative benches.

Deriding the “politics of the playground”, he said: “Both of them are willing to spend money on almost anything; neither of them are willing to raise the money necessary from anyone.”

Prof Drakeford said the chancellor returned national insurance broadly to where it had been as a share of gross domestic product for 13 of the 14 Conservative years.

The former First Minister pointed out that the UK Government offset national insurance rises on small employers by more than doubling the employment allowance.

He told the debating chamber or Siambr: “If you want to pay for things, you have to find the money to do so. That is what the chancellor had to do. That is how we will get the money that will come to public services here in Wales.”

Senedd Members voted 25-19 against Plaid Cymru’s motion.

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