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GP practices serving the most deprived parts of Wales are under-resourced, overworked and facing collapse despite experiencing the greatest patient need, a committee heard.

Adrian Edwards, a professor at Cardiff University, gave evidence to a Senedd health committee inquiry on the future of general practice today (November 6).

Prof Edwards, who retired from practice in May, reminded Senedd members of the inverse care law – a term coined by Julian Tudor Hart, a GP in Glyncorrwg, Afan valley, in 1971.

It states the availability of good medical care tends to vary inversely with the need for it in the population served, so those who need health care most often have the least access.

Prof Edwards warned the UK is lagging behind other countries, with 45 GPs per 100,000 population compared with Australia (121), Canada (103) and New Zealand (74). He added that Wales was bottom of the UK table, according to latest statistics.

‘Inverse workload law’

The academic, who was a GP partner for 25 years at a practice which handed back its NHS contract in 2020, said the number of partners has declined every year for a decade.

He told the committee the number of patients per full-time GP has increased in that time, with the total number of consultations also rising since 2019.

Prof Edwards said: “What we also have is an inverse workload law. In the affluent areas of Wales, the average number of patients per GP is 2,100 and in deprived areas it’s 2,400. And, by the way, those practices get 7% less income to provide those services.”

He explained doctors in the poorest areas have more patients to start with, who present about twice as often as those in more affluent areas.

Prof Edwards said the number of GPs has been largely flat since 1947, with resources being funnelled into hospitals “trying to do cure and not doing prevention”. He said the proportion of NHS spending on general practice in Wales has fallen from 11% to 7.6% over 20 years.

‘Quietly drowning’

He cautioned that focusing on reform of the Carr-Hill formula used to allocate funding to GPs is a zero-sum game: “If you help someone, you’re taking away from someone else.”

Prof Edwards said 10% of GPs aged under 40 left the workforce in 2023, warning: “We’re haemorrhaging, we’ve got to do something about it immediately.”

Deep End Cymru, a network of GPs working to improve care in the most deprived areas, warned practices in less well off parts of Wales are “quietly drowning”.

Jonny Currie, a GP partner at Ringland surgery in Newport, said for every 10% increase in patients from the poorest areas – practice income falls by an average of 1%.

Dr Currie, policy lead at Deep End Cymru, told Senedd members: “We’re looking at tens of thousands less money coming into general practice,” despite greater demand.

‘Societal disintegration’

Neil James, chair of Deep End Cymru and a GP partner in the Rhymney valley, added: “What we have seen is practices collapsing, going to the wall in many of these areas.”

Dr James, a GP for 22 years who is from Senghenydd, told the committee: “Inverse care has always affected us… having lived and worked in the valleys… you’ve seen societal disintegration and the effects that has on patient health has been profound.”

He pointed to a lack of training practices in poorer areas as a key problem, with GPs so busy at the coalface that they lack capacity. He said his practice faces ‘wall-to-wall deprivation”.

Prof Edwards raised statistics showing 10% of practices in the poorest areas closed or merged, compared with 2.8% elsewhere, over the past three years.

Deep End Cymru’s evidence laid bare the human cost of such inequalities.

The network of 91 GP practices warned women in the most deprived communities spend an average of 16.9 more years living in poor health. For men, the gap is 13.3 years.