Two GP Surgeries in Rhondda Cynon Taf Facing Closure Due to Staffing and Financial Challenges, Residents Concerned

Two GP surgeries in Rhondda Cynon Taf (RCT) could close because of difficulties in recruiting and retaining GPs, the long term sustainability of services and costs associated with building maintenance
Taff Vale medical practice made an application to Cwm Taf Morgannwg Health Board in September 2023 to close two of its four branch surgery sites located in Cilfynydd and Ynysybwl.
The main reasons for the application included that it has experienced increasing difficulties in recruiting and retaining GPs and that fewer sites make the practice a more attractive place to work due to a more supported and less isolated working environment.
Another reason is that a reduction in the number of sites would lead to the longer-term sustainability of the practice through co-locating staff on fewer sites.
The application also mentioned the ability to improve access to same day urgent care and said that both premises require considerable costs associated with building maintenance.
Taff Vale Practice is an independent contractor commissioned to provide
general medical services to its whole registered population. Their
population covers a large practice area comprising 16,056 patients.
A Cwm Taf Morgannwg Health Board report said that postcode data shows that approximately 1,496 patients live in Ynysybwl and 1,516 in Cilfynydd.
Of the total patient population in Ynysybwl (approximately 4,581) nearly 66% are registered with other GP practices whose practice area include Ynysybwl and Coed-y-Cwm.
And of the total patient population in Cilfynydd (just under 3,000) nearly 41% are registered with other practices whose practice area include Cilfynydd.
The report said it is unusual for a medical practice with the numbers of patients registered as above to run three sites let alone five sites as it provides many more operational challenges and, with rising premises costs, adds expense that can be better directed to ensuring quality services.
The public feedback
Since September 2022 there have been no primary care services at all
available from Cilfynydd Surgery and Ynysybwl surgeries.
The health board has carried out a branch practice review process and the application was considered at Contract Variation Group (CVG) on September 29, 2023 which agreed to support the application to close
the branch sites subject to consultation.
During the nine week consultation between January and March of this year and feedback showed that most of those who responded wanted both branch surgeries to remain open.
People said that Cilfynydd Surgery is a much-valued service, and the community would like it to remain open with patients asking for both surgeries to remain as a building serving the community in an alternative way.
People felt that closing the branch surgeries would result in patients having to travel further and that this would be less convenient for them. Many patients noted the lack of public transport, their inability to drive and the cost of taxis.
There were widespread concerns raised that the elderly, immobile, disabled and most socially and physically vulnerable patients would find it very difficult to get to Dewi Sant and Rhydyfelin should the branch surgeries in Ynysybwl and Cilfynydd close and therefore be disadvantaged in terms of their care.
And several people criticised the extent of the engagement period and said that the practice and health board should have done more.
The practice said it listened carefully to the feedback raised both before the formal engagement period and during.
It said that the landscape of primary care is changing and cannot be ignored  and that it strongly believes it is trying make hard decisions now that protect the future healthcare it can provide adding that continuing to operate over five sites would mean the sustainability of the overall service would remain at risk
Background
In March 2020 the pandemic forced the practice to consider operating out of fewer sites to protect staff and patients during a difficult and worrying time so Rhydyfelin and Dewi Sant were adopted as the green (clean) sites and Glyncoch as a red site.
As a result for a number of years there has been an extremely limited service provision from both Cilfynydd and Ynysybwl branches with no enhanced or extended services having ever been offered and more complex nurse/healthcare assistant appointments having always been run from the main site in Rhydyfelin.
The report said that the most recent statistics going back to pre-Covid suggest over a six month period approximately 3% of patients living in Cilfynydd accessed services at Cilfynydd and just under 4% of patients living in Ynysybwl accessed services in Ynysybwl.
The report said that although most of the concerns raised during the patient engagement process applied equally to both surgeries, it is probably true to say the negative impact of closing Cilfynydd Surgery will be greater than that of closing Ynysybwl Surgery mainly due to access to an alternative and public transport issues.
If Cilfynydd Surgery is to close patients have no option other than to travel
to Dewi Sant, Rhydyfelin or Glyncoch. The transport issues highlighted by
the residents of Cilfynydd will impact significantly on those patients who are
reliant upon public transport, the report said.
Census data 2021 suggests up to 20% of the local population of Cilfynydd do not have access to a car. The public transport service is not comprehensive from the village, it added.
The health board has contacted local transport providers in the area but
there are no proposed changes to the services currently operating. There
are a number of voluntary transport services operating in Cwm Taf
Morgannwg University Health Board but these are mainly targeted at
patients requiring transport to the hospital sites.
It is more challenging for them to provide short notice journeys. They do transport people in wheelchairs, however due to safety and vehicle constraints, there are limits to the level of disability volunteers can support, the report added.
There is potential scope  for further development of local community transport options, and the health board said it can provide support to the practice should this be something local people may need
But of the local population living in Cilfynydd approximately 50% are already registered with practices whose main surgery sites are in the town centre.
If Ynysybwl surgery is to close patients can travel to Glyncoch, which is less
than three miles away, or they could register with Eglwysbach Surgery, who
also have a branch surgery in Ynysybwl.
The practice has confirmed its intent to improve the range of services delivered from Glyncoch which will help improve access for those patients with transport difficulties living in Ynysybwl.
Over the last two years (where there have been no face-to-face
appointments offered from either Cilfynydd or Ynysybwl) Taff Vale Practice
feels that it has continued to meet the reasonable healthcare needs of its
population.
Measures to minimise the impact of the closures
The practice will have measures to mitigate the impact of these closures including: ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Increasing its capacity for appointments across the remaining three sites
(with specific emphasis on Glyncoch) and offering flexible appointment times for individual patients.
Switching to 15-minute appointments so multiple issues can be
managed in one appointment.
Where possible enable patient choice to switch the mode of that
appointment from face to face to telephone if it suits the patient
better
Increase capacity for home visits should the demand increase which may be through enhancing the home visiting service already in place.
Two duty GPs at all times for urgent clinical needs, and in order to
clinically supervise the multi-disciplinary team.
Work with the health board, patients and community pharmacy to
understand what is important to local people, particularly those that
are vulnerable, and explore opportunities to expand services offered
for example the Common Ailments Service and Pharmacist Independent Prescriber Service (PIP). ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

Cwm Taf Morgannwg Health Board will consider the application for the closures at a meeting on Thursday, July 25. ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​

By BBC LDRS ‌​‌​‌​​​‍‌​‌​​‌‌‌‍‌​‌‌​​‌​‍‌​‌‌‌​‌‌‍‌​‌‌‌‌​​