‘Alarm bells should be ringing’.­

Staff at an under-threat GP surgery in Borth have warned that other rural practices and pharmacists will follow if health bosses allow it to close.

Dr Sue Fish, partner and GP at Meddygfa Borth Surgery for more than 30 years, has called for immediate action to safeguard the long-term future of the small practice – which she argues will save other services and avert a ‘healthcare crisis’.

She along with retired Borth GP Ian Hosker and practice manager Jacqui Jones Brown painted an ominous picture for the future of rural medicine in Ceredigion and Wales.

They argued that the county could see at least two smaller GPs and several pharmacists close in the next five years, leaving only larger towns and villages with accessible care for their residents – and leaving many situated in rural areas stranded.

As the Cambrian News reported earlier this month, staff warned the surgery will close unless it can recruit more GPs, with the current situation likened to a ‘sinking ship’.

The surgery’s patients have reacted with anger and sadness at the thought it could soon close – including Martin Timmins, a registered patient for more than 23 years, who says the staff have ‘saved his life four times’.

The surgery, located on the High Street, was built in 1995 and it was thought it could be forced to close its doors as early as August.

The contract to operate the surgery will be sent back to Hywel Dda University Health Board when Dr Fish retires, after which it is widely expected that bosses will decide to axe the practice and disperse patients into other services.

But this week the surgery was granted a temporary reprieve when a doctor answered the call and secured a job as a new salaried GP – after leaving Tywyn surgery which has also faced the threat of closing.

This will mean Dr Fish is granted the improved working conditions she has been seeking to continue a year or two longer as partner, training the new doctor.

But this far from guarantees a long-term future for the surgery.

Dr Fish and Dr Hosker – who works only one day per week – have been taking on the significant workload at a time when services across the Welsh NHS are stretched to breaking point.

They have been trying to recruit a new GP for longer than a decade, and have had no success until this week.

The surgery’s prospective closure would mean the loss of 22 jobs.

The Borth practice serves about 2,750 people including the populations of the neighbouring rural villages of Bow Street, Llandre, Penryhncoch, Tre-taliesin and Tre’r-ddôl.

And that figure rises to nearly 10,000 during the tourist season.

Campaign group Borth 2030, which is dedicated to exploring future opportunities for the seaside village, started the online petition to save the surgery after consulting surgery staff and the community council.

It has gained nearly 450 signatures since it was set up last week.

Paper versions are also available to sign at Premier and Nisa shops in the village, the community hub, the pharmacy, the surgery itself and the community-run café in Tre’r-ddôl, Cletwr.

Staff claim that Hywel Dda officials have - in no uncertain terms - informed them the surgery would close if the contract is handed back.

Dr Fish says this would be a disaster and called on Hywel Dda to formulate a plan for general practice across the region and the Welsh Government to outline a distinct policy for rural healthcare – as is the case in Scotland.

“If it’s happening in Borth, it’s going to happen everywhere,” she told the Cambrian News last week.

“If you look at Ceredigion as a whole, I believe Llanybyddyr is a branch surgery of Lampeter but we’ve lost the smaller surgeries in Llandysul, Aberaeron and Cardigan and that’s all happened in the last 10 years - so we’re on that worrying trajectory.

“If Borth shuts we will be the first surgery where there isn’t an automatic larger surgery to absorb patients but then you’ve got Llanilar, Tregaron and New Quay – and they’re not much different from our demographics and so they won’t survive long unless things change.

“It is all dependent on the age of the GPs who are there and when they will retire – and I know at least two colleagues who are at retirement age.”

Staff argue that pharmacists in Talybont, Borth and Tregaron may also be forced to close without a nearby surgery to supply patients’ prescriptions.

Dr Fish, Dr Hosker and Mrs Jones Brown claim they have been arguing, along with many others, for a plan to safeguard rural surgeries in the Hywel Dda area, but their recommendations have fallen on deaf ears.

They recommend, as is possible in England, that an Alternative Provider of Medical Service model should be adopted – which would allow the surgery to stay open without the requirement for a GP to be constantly on site.

“Nobody apart from a GP partner can hold the contract but many are in the same situation as us that when the older partner retires it will leave the slightly younger partner with the contract on their own and then it becomes very difficult,” Dr Fish said, speaking before she hired a new salaried doctor.

“Because the other problem as a partner is that unless you have got other salaried doctors around, you can’t take holiday – you can’t be ill – you’re the only one that must be there.

“But other staff also take appointments who are very competent, so it doesn’t have to hinge on the presence of an on-site GP at all times.

“We have already gone down the route – as the Welsh Government is promoting – of different types of healthcare professionals supporting the GP in providing services. But ministers haven’t found a solution yet to the dwindling GP numbers – and these people that we’re being told will run primary care of the future aren’t able to work currently unless there’s a GP on-site in rural surgeries – so the model falls over at that point.

“The Welsh Government – but some of it is within the health board’s gift as well – must come up with alternative models for how we can legally provide services in rural areas.”

Welsh Government figures released in November show that between March and June last year three GP practices had closed in Wales – and 23 fully qualified GPs leaving the profession. Similar figures show the number of GPs working under Hywel Dda has grown since 2020 – but this may not reflect the reality in rural areas, where recruitment has proved very difficult.

On the struggle to recruit GPs, Dr Fish said: “It’s complicated. A lot more of the GPs are choosing to work part-time due to the pressure of the job. Not all GPs work in daytime practice, they work in the Out of Hours Service and other health board jobs.”

The similarly remote and rural village of Solva in Pembrokeshire has seen its GP partner hand back the contract to run the surgery to Hywel Dda.

But Dr Fish says there is no indication from the health board that it will allow the surgery to close as it appears likely in Borth’s case. This is despite the patient population it serves being of a very similar size.

The trio suggested there was a southern bias among the senior figures in the health board, with many of its management offices located in Carmarthen and Pembrokeshire.

“They don’t want to lose their own services,” Ms Jones Brown remarked.

Dr Fish also bemoaned the health boards being encouraged to prioritise the delivery of hospital services over general practice.

“Health boards are just worried about hospitals the whole time and worried about people queueing outside A&E,” she said. “But if there are no GP services the queues are going to be much longer.

“About 90 per cent of NHS activity occurs in GP surgeries – and only 10 per cent occurs in hospitals. Yet GPs get under 10 per cent of the funding.”­

She added that, not only should GP surgeries get more support, those in rural areas would benefit from a clearly outlined Welsh Government strategy to preserve them.

“We currently don’t have any rural policy for health in the Welsh Government,” she said.

“We have had in the past – we’ve had papers – but those have expired and we currently haven’t got any established policy.

“I’m part of the Welsh Medical Committee and I submitted a letter to the chief medical officer in the last two months encouraging it to raise these problems with the Welsh Government – in particular that they need to have rural health policy like they do in Scotland.”

Eglwysfach resident Mr Timmins, aged 65, who has suffered with two heart attacks, pneumonia and sepsis since 2018, says he wouldn’t be alive without the surgery staff’s vital home visits, which would disappear if it closed.

“Staff have saved my life four times. It’s the best surgery I’ve ever had. The doctors are fantastic – they’re so accommodating and professional.

“I can’t understand why our councillors, our MPs – who are supposed to be looking after us patients – and the health board haven’t got us a doctor! What are they doing!?”

His wife says she would have been in a wheelchair were it not for the staff identifying her polymyalgia – which went undiagnosed for 13 years.

Ex-Ceredigion MP, Borth resident and chair of the North Ceredigion Forum for Older People’s Care, Mark Williams, said: “The forum is in full support of Borth Surgery and the value it also brings to this area. We urge HDUHB to increase and ramp up the search for a new GP so that the surgery’s work can continue.”

Another Borth resident, Andy King said: “We need our local GP surgery! Not everyone in the village is fit and mobile. Some of the elderly would suffer if our surgery was to close. I believe many people would be put off by seeing a doctor if they had to venture out of the village.”

The petition itself reads: “We strongly request that Hywel Dda University Health Board enter urgent, meaningful discussions the community to ensure the continuation of locally accessible general practitioner and other community services closer to home for the current and future patients of Borth Surgery.

“The ramifications of a reactive, poorly thought-out solution are far broader and serious than just for the community of Borth and its visitors.

“This is the opportunity for Hywel Dda to lead the way in providing an innovative model for the provision of primary care in a rural setting. A model that is collaborative, well planned and that works for all concerned.”

In response to suggestions that the health board will allow Borth surgery to close, a Hywel Dda spokesperson said: “If the practice terminates its contract, then the health board, in line with national process, will hold a Vacant Practice Panel which will identify options for public engagement and ultimately a recommendation to its board.”

Though Borth Surgery staff say officials have all but confirmed its closure during internal discussions.

In response to the suggestions by Dr Fish that the APMS model could be used to preserve under-threat rural surgeries, the spokesperson said: “This is not the health board’s understanding of APMS if it was being used as a mechanism to deliver general medical services.”

Ms Jones Brown told the Cambrian News that Borth Surgery’s proposal to use such a model has been with Hywel Dda’s legal team for more than five years.

The spokesperson added: “The health board recognises the challenges faced by GMS services generally across Wales and is involved in national discussions to explore more sustainable arrangements for future discussion at a local level.”

Staff warned that if Borth Surgery is lost, not only will A&E services receive more patients but other general practice patients in the region will experience longer waits.

They added that the surgery is a registered training centre for doctors and now nurses – after the opening of Aberystwyth University’s course.

But the surgery and its federated training practice in Aberaeron will have to cease training if it closes.

“The fewer GP practices there are the fewer placement opportunities there are,” Ms Brown said.

Crucial groups such as diabetic eye screening, liver clinics, substance misuse services, and a pain psychologist operate from Borth Surgery and will lose their base. This also applies to the district nurses team which is situated at the practice.

Dr Fish concluded by warning of a state of affairs – which she predicts could take shape in less than five years – where only Aberystwyth, Lampeter, Aberaeron, Cardigan, Llandysul and maybe Newcastle Emlyn have practices.

She said: “We are on a trajectory in Ceredigion of losing our GP surgeries – as is every health board in Wales.

“Losing them will cost lives. We need a new approach.”