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Transformation of Welsh Primary Care - too slow

Wales auditor general calls for greater pace

Jo Carlowe

Tuesday, 22 October 2019

Despite investment and plans to transform primary care in Wales, change has not happened quickly enough.

This is the message from the Wales auditor general’s report on primary care services*, published this week. 

While the NHS and Welsh government are taking steps to strengthen primary care, change needs to happen at greater pace and scale to tackle longstanding challenges and ensure vital services are fit for the future, the report states.

There remains growing pressure on the traditional model of primary care and patients are experiencing continued difficulties in accessing appointments with a GP. The proportion of people finding it difficult to get an appointment decreased slightly from 42% in 2017-18 to 40% in 2018-19, although this level remains of concern and varies across Wales.

In recent years there have been a number of developments that have sought to strengthen the planning and delivery of primary care services in Wales. Most notably, the establishment of primary care clusters and the introduction of a National Primary Care Fund that allocated £120m to health boards between 2015-16 and 2017-18 to support the development of primary care through various initiatives including the national pacesetter programme. 

And, during the last few years a new Primary Care Model for Wales has evolved, which promotes the development of multi-professional primary care teams to reduce the current pressures on GPs and to improve access and services for patients. However, progress on implementing the model is patchy and the pace of change needs to be increased, notes the report. 

There is also a need for ‘better engagement with the public to ensure they understand the new ways of working,’ states the report, and a need for ‘understanding and support for the model amongst NHS staff.’ 

The report sets out national-level recommendations for the Welsh government and the National Primary Care Board, including:

  • Consulting with health boards to agree an approach to clarify and standardise the way primary care expenditure is recorded and reported.
  • Driving implementation of the Primary Care Model for Wales and developing, collecting and publishing regular data to help gauge progress.
  • Involving the public more in primary care changes.

Auditor general, Adrian Crompton said: “Primary care services play a vital role in the system of health and care in Wales. Whilst there has been a range of plans to develop primary care, progress in implementing these plans has been limited and primary care has not always had a high enough profile within the NHS in Wales. This has to change, and the new model that is envisaged for primary care needs to be rolled out at a quicker pace and on a larger scale, and with appropriate engagement of staff and service users. Failure to do so will create some real challenges to the sustainability of these vital services.”

Dr Phil White, chair of the British Medical Association’s (BMA) Cymru Wales’ General Practitioners Committee, welcomed the findings in the report.

“After years of underinvestment in primary care we have been looking towards this new period of investment and policy development with growing impatience.

“We share the concerns that change is happening at too slow a pace and with too limited scale, something we’ve been highlighting for years. It’s no good to inject a single lump sum of cash into the system and expect effective change, increased funding needs to be supported by the spreading of good practice and sustainable ongoing financial support for successful schemes.

“BMA Cymru Wales has repeatedly warned of the growing gap between the demand placed upon general practice and its capacity. Primary care has historically suffered years of underinvestment while workload for GPs continues to rise year on year… Measures must to be taken to improve the pace and scale of improvements to primary care services. Patients and doctors across Wales have already waited too long.”


*Primary care services in Wales. A report prepared by the auditor general for Wales, 22 October 2019

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