DOCTORS’ leaders welcomed an agreement bringing GPs in Wales an extra £27 million next year - but serious concerns remain about the future of the profession among those in practice.

Fears over unsustainable workloads, the demands and usefulness of the current quality monitoring system, who should control the purse strings for enhanced services, and the ongoing challenges of recruitment and retention, were among the topics debated at the annual conference of Welsh Local Medical Committees in Newport.

And there were sombre messages from family doctors across Wales on these and other issues.

A call for GP practices to be able to close their lists to new patients when they reach a workload level where safety is threatened, was approved.

Dr David Bailey, conference agenda committee member for Gwent, called the idea a “no brainer” and also said that overspill centres to deal with unscheduled care that cannot be safely dealt with by existing practices would be a solution in some parts of Wales.

“There are areas where workload is manageable, and others where it is completely unsustainable,” he said.

“We need data (on the issue) and that will come in next months. There is a need to define a safe workload.”

Conference delegates also voted to demand a cap on “the number of patients a GP can safely see in a day, for the safety of patients and the sanity of GPs.”

The Quality and Outcomes Framework (QOF), for monitoring care quality in general practice in Wales was also criticised at the conference, held at the Celtic Manor Resort.

Briton Ferry GP Dr Heather Wilkes said it had helped provide things like accurate disease data, but has outlived its purpose, while north Wales GP Dr Sara Bodey said the QOF has “distorted clinical priorities” and “helped drive GPs’ workload to the precipice.”

The system was suspended this winter to ease workloads and health secretary Vaughan Gething, addressing the conference, said a wider review is imminent.

But Dr Charlotte Jones, who chairs Wales’ GP committee, urged caution over calls to dispense with it, warning that something more onerous might replace it.

There were also calls for measures to encourage GPs nearing retirement to stay on, given recruitment and retention issues.

GPs also want funding for services developed and proposed by GP ‘clusters’ - area groups of practices also known as Neighbourhood Care Networks - to be given directly to the clusters, rather than allocated through health boards.

There is a view among GPs that health boards only release such funds if a proposed service fits its priorities, whereas many believe doctors are better placed to determine what services should be a priority for their patients.

Mr Gething told the conference that GP clusters are a key component of healthcare. He wants them “to continue to develop as multi-disciplinary teams” and challenged “health boards to demonstrate that they are shifting resources into primary and community care.”

Acknowledging that primary care reform is a challenge in given continuing austerity, Mr Gething said doctors have a key role to play.

“Leadership must come from people like yourselves. It’s about the way the healthcare system changes, and for that we need a strong clinical voice,” he said.

Reform of the general medical services (GMS) contract in Wales is on the agenda too, Mr Gething and Dr Jones stressing that a collaborative approach sets Wales apart, given the confrontational nature of negotiations over such issues in England.

“The Welsh Government acknowledges the linchpin position of general practice in healthcare,” said Dr Jones.

Progress has been made, she added, and “there is much to be positive about” but warned that the profession is “still very demoralised.”