Patients at a GP surgery in Wales which is days away from closure have spoken of their worry over the impact of the plans for the future of their village and its community. A wave of practice closures has hit small towns and villages hard across Wales and hurts most in communities like Gilwern, which a few years ago had two practices and a smaller population, and by March will probably have no doctor at all.
The average age of people in Gilwern is 49 - higher than the average across Wales at 42. In a rural area of Powys poorly served by public transport, any elderly or vulnerable people among population of 2,500 will find it difficult to reach alternative surgeries in nearby Crickhowell.
"It's not just a doctor's surgery, it's an important part of the community," councillor Fay Bromfield told WalesOnline, walking through the main village street where she part owns a butcher's with her husband. The street in the centre of Gilwern is nicely busy for a week day. Fay's butcher's shares the thoroughfare with a salon, a TV shop, a chemist and two pubs among other traders - many of whom share her concern for the place if it is to lose its last surgery.
"I speak to many people here and they are outraged by the news, they are worried," Fay, who has set up a petition in her shop to fight the closure after residents received letters informing them of the news earlier this month, continued. "People come into the village and they pop into the doctor and then they use the shops and the chemist. We all help each other, and it's important a community like this stays that way."
Fay and the neighbouring traders are well-used to challenges. As if the impact of the pandemic was not enough, drawn out roadworks at the Heads of the Valleys Road between Brynmawr and Gilwern which only ended last year - five years behind schedule - led to financial worry and almost led to traders having to lay off staff. "We've just come off the back of that and are starting to see some normality," Fay added. "I’m not doing this in my remit as a county councillor - I am doing it as a very concerned business owner and resident."
Government statistics reveal that one in five GP surgeries have closed in Wales in the last decade. As of June 2022 there were 386 active GP practices in Wales - down from 474 in 2012. Instead, there are more GPs in Wales practicing in larger surgeries in larger towns and cities. Since 2012 the number of GPs in Wales rose from 2,015 to 2,301 as of last year.
While Monmouthshire comes under the auspices of Aneurin Bevan University Health Board, Belmont surgery in Gilwern is overseen by Powys Teaching Health Board, as it is a satellite surgery connected to Crickhowell Group Practice. It means people in the village will now need to travel to Crickhowell whenever they need to see a doctor.
Fay said many elderly people in the village do not drive and will struggle to see a GP if Belmont closes. “There is no bus to Crickhowell from Gilwern. You’d have to go from Abergavenny to change buses to go to Crickhowell, which could take hours,” she explained. “There are lots of people here who don’t drive and walk to the surgery, people that live next to the surgery who rely on it. So how are they expected to get to the doctors?"
Bryan and Sandra Oliver, both in their eighties, told how the village has changed in recent years. “The population here has risen significantly and houses are being built all of the time,” Sandra said. “When we moved here Gilwern was much smaller in population and had two GP surgeries. The first surgery closed quite a few years ago and turned into a hairdresser's. It’ll be impossible to get an appointment (in Crickhowell).”
Bryan said: “GPs are in such demand now, why would you come to Gilwern when you can go and earn big money elsewhere like London or Essex?”
Similar stories of GPs applying for closure have emerged in recent days including in Bedwas in Caerphilly borough and Borth in Ceredigion. A spokesperson for the health board said Belmont Surgery is suffering nationwide challenges in recruiting new doctors, including growing workload pressures on general practice, more people leaving the profession than joining, and increasing numbers of doctors choosing to retire early.
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said there remains a "chronic shortage of GPs". “GPs want to be able to consistently give their patients the care they deserve, no matter where they live in the country,” she said. “But the increased workload expected of GPs and their teams, coupled with the chronic shortage of GPs, is unsustainable.
“Overall, the GP workload has increased by 18% since 2019, and this is having an impact on experienced GPs, who are overstretched, exhausted and burning out. Sadly, this is causing some GPs to evaluate their career in general practice and more GPs are now leaving the profession than are joining it, due to concerns about delivering safe patient care and the impact these intense pressures are having on their own wellbeing.”
Professor Hawthorne has explained how areas experiencing higher levels of deprivation are disproportionately affected. “While the intense pressures on GP services are being felt across the UK, some regions are being affected worse than others,” she explained. “We are particularly concerned this is happening in more deprived areas of the country, where patients are more likely to have multiple and increasingly complex health needs, so we urgently need to see extra funding for practices serving the most deprived populations to help recruit and retain staff in under-doctored areas, as well as a comprehensive review of retention and recruitment initiatives.”
Leader of Monmouthshire County Council Mary-Ann Brocklesby said villagers are concerned the closure of the surgery in Gilwern could be "another nail in the coffin". “We have set up a meeting with Powys Teaching Health Board and Aneurin Bevan University Health Board," she said. "There is a lot of worry and I am being contacted every day by people who are very concerned. When I was campaigning in May people were already concerned about it because it had become very difficult to get an appointment at the Gilwern surgery.
“There is older person accommodation just behind the surgery, some of whom relied on being that close to the doctor. There are a lot of older people in the Gilwern area because it’s where people retire to, and yet there are no direct buses to Crickhowell. So once you take that satellite surgery away, being attached to a Gilwern surgery isn’t necessarily where you want to be. We need more facts in front of us to understand where the responsibility actually lies.
“The impact of a surgery on a village like Gilwern can’t be underestimated, because people pop into the surgery and then go into the village to get a prescription, they might stop at the shops and the pub for a coffee. It’s actually a part of a vibrant community and some of the concerns that have been expressed to me are around that fear that it could be another nail in the coffin."
Dean Williams, a business owner who lives in Gilwern, said: “We were surprised no-one has been found to take it on and we’re obviously concerned, especially for the older community members who ironically probably need a surgery here more today than they have before."
Picton Williams, 79, who doesn’t own a car and uses a mobility scooter, lives less than 100 yards from the surgery, which he says has been a blessing. He said he was shocked when he received the letter from the health board this month. “It’s been good to have it so close,” he said. “I’ve used it for check ups mostly for my blood tests and diabetes. I don’t have a car, so I’ll have to try and get my niece to take me to Crickhowell now. It’ll be a hassle won’t it?”
Hayley Thomas, Director of Primary and Community Care and Mental Health Services for Powys Teaching Health Board, said: “Powys Teaching Health Board has received an application from Crickhowell Group Practice to close their Belmont Branch Surgery in Gilwern. The main reasons for the application are: the forthcoming retirement of four GP partners who are the owners of the branch surgery premises, lack of viable alternatives for transfer of ownership, challenges across the UK to recruit and retain general medical practitioners.
"The health board has therefore implemented its branch practice review process, which includes: receiving and reviewing the application from the practice, sharing information with patients and wider stakeholders to seek views, engaging with the Community Health Council which is the statutory body to represent the interest of patients and the public, conscientious consideration of the feedback we receive, and taking this into account when making a decision on the application at a meeting in public of Powys Teaching Health Board. This period of engagement is taking place from January 10 to March 6. The health board has written to patients registered with the practice so that they can find out more and make their views known, and further information is also available from our website at www.haveyoursaypowys.wales/gilwern."
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