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Taking it on tour | #RCPWalesRoadTrip

A warm welcome and a sense of belonging.

When I started as RCP vice president for Wales during the summer, I was determined to spend my first few months getting out and about, visiting colleagues across Wales and finding out more about how local health systems work. What are the challenges you face? What are the solutions you’ve found? How can we spread this learning and share best practice?

In September, I embarked on a pan-Wales road trip, with visits to Morriston Hospital in Swansea Bay, and Prince Philip and Glangwili hospitals in Hywel Dda. Our regional adviser for south-west Wales Dr Sam Rice was an invaluable source of advice and information as we met with colleagues and toured around hospitals in the west.

I came away very impressed with how colleagues working in more rural and remote areas had developed a service and training model that prioritises high standards while retaining a sense of family and community. A special thanks to the postgraduate centre staff in Llanelli and Carmarthen who made us feel so welcome.

A couple of weeks later, I found myself in a Fiat 500 with Lowri Jackson, our head of policy and campaigns, travelling up the A49 towards Wrexham Maelor Hospital. We spent a fascinating afternoon with consultants, trainees and the health board medical director, discussing their concerns about upcoming winter pressures and a growing workforce crisis, before heading to Ysbyty Gwynedd in Bangor to meet with Dr Rachel Newbould, our college tutor, who had set up a day of conversations and presentations for us.

During our time in north Wales, we heard from more than 80 doctors, including some foundation year doctors who had just graduated from the brand-new Bangor University Medical School in 2023. We met international medical graduates, trainees, new consultants, specialty and associate specialist (SAS) doctors and consultant physicians as well as clinical directors (and even those who had retired and returned part-time for winter – I’m filing that job plan away for future reference!). A huge thanks to Dr Ben Thomas, our regional adviser for north Wales for his support during the trip.

So what did I learn from our physician community in Wales? Our doctors care very much. They care about delivering safe, effective, realistic medicine. They care about the community they live and work in. Teamwork matters. Time and time again, we heard about the value of supportive experienced MDT colleagues and inclusive teams.

Our hospitals are not standing still. We heard about the delivery of overnight dialysis that has improved quality of care and patient outcomes, new academic foundation training jobs, effective and engaged junior doctor forums, successful same day emergency care (SDEC) models and structured support for international medical graduates (IMGs) joining Welsh hospitals.

Smaller hospitals serving a rural or remote population

A real stand out for me was the importance of the smaller local hospital. We were welcomed with incredibly warm and open arms. Consultants told us about the close networks, the ease of working together, the continuity of care they deliver. Trainees were able to learn and develop their skillset as part of a wider team. For many, it is a choice to live and work in a smaller hospital, despite the challenges of rota gaps and fragile services. It’s also about the worklife balance it can offer – I wonder how many people keep paddle boards, walking boots and climbing harnesses in the boot of their car, ready to escape! But for new IMGs, the lack of public transport is a real challenge. This reminds me that the wider social determinants of health should always be at the back of our minds.

In fact, as we drove south through misty windy roads from Bangor to Aberystwyth, it really brought into focus how many people in Wales live rurally with limited public transport. I want the RCP in Wales to understand and explore the importance of smaller hospitals and rural healthcare. How can we sustain and support more remote local hospitals to deliver high-quality, accessible local care, especially those that serve an older, often sicker population, living far away from urban tertiary hospitals?

We need to decide together what smaller hospitals can do in a safe and sustainable way. Hospitals don’t exist in isolation. They are an important part of a much bigger ecosystem, and we need to work out how they integrate with critical care and social care at either end of the scale. During the school holidays, some of our smaller hospitals are expected to cope with a huge increase in local population as the tourist season brings an influx of visitors. More to come on this in 2024 – and, as ever, I’m keen to know your views. Please do also share any feedback with us as well as your successes and challenges.

Health inequalities: the elephant in the room

From Bangor, we headed south to a timely Plaid Cymru autumn party conference in Aberystwyth where we hosted a main stage debate on rural health inequalities – my first visit to a party conference. During the debate we were asked about early intervention: an audience member’s neighbour had developed arthritis, joined a growing waiting list, had developed high blood pressure and depression in the meantime, and is now unable to work. It was a sad story, one that I’m sure is replicated in many parts of the country.

The political hot potato of social care

Ultimately, however, we cannot ignore the acute medical care crisis at the front door. It was hard to hear very experienced medical consultants describe an on-call shift in which every single patient had to be examined in a chair – the only patient in a bed was in ITU. Trainees wondered aloud how PACES exams could ever reflect the real world. They despair of providing safe, quality care – the sort of care that patients deserve.

We all know the problems. Beds and wards were designed for a world when the number of patient admissions into hospital was equal to the number of patient transfers into community or social care. Many hospitals have found innovative ways to reduce admissions – SDEC and frailty units for example – but too many patients are waiting weeks, sometimes months to leave hospital, and sadly, many of them are trapped in a miserable spiral of worsening health and frailty. We need to be clear that both acute and planned care rely on patient flow out of the hospital and without long-term funded solutions to the social care crisis, we will continue to pay the price at the front door.

Dr Hilary Williams
RCP vice president for Wales
Consultant medical oncologist