A GP Surgery in Wrexham has opened up on the current pressures they are facing while trying to provide patients the best service they can.

Caritas has been running for over 15 years and has surgeries in Cefn Mawr and Coedpoeth, with 8,000 patients registered to the practice.

Since Covid, pressures on the healthcare sector has ramped up across the board, and GP practices are feeling the heat too.

With not enough time or resources to fit every patient in, workloads increasing, and funding drying up, Caritas was forced into a change of system in an attempt to improve the situation.

Practice Manager, Nicola Jones said: “We needed to change really, during covid we had doctors working until 10pm to get all their jobs done.

“Our funding has decreased, and our workload has tripled, and staff numbers are reducing, it’s tough but it’s the reality.

“We acknowledge that perhaps it could be better, but we’re doing everything we can to help our patients.

“We just want to make sure we are finding the best and most appropriate course of action for their problems.

“We do get complaints from patients, sometimes along the lines of ‘fobbing off’ but there is only so much a GP practice can do, for medical emergencies such as chest or heart pains, it must be A+E.

“Of course, we want to help every one of our patients, but it’s not always the best course of action for them to see a GP, their needs can be fulfilled elsewhere.”

The receptionists at Caritas play a key role in organising appointments and helping patients with any potential issues.

The new system, which relies more on the patient to explain symptoms via a series of online questions, allows the receptionists to swiftly book patients into available slots depending on the severity of symptoms.

It is open from 8am-2pm Monday to Friday, to prevent the 200 requests waiting for them first thing on a Monday. From 2pm to 6.30pm, medical emergencies can be taken by telephone.

The aim is to ensure patients who need to be seen are seen within 48 hours, and more routine requests to be seen in the week that the patient requests it, with our new system this is more achievable.

 On some days the surgeries can deal with all requests, on the days that they can’t due to staffing levels then they have to prioritise patients with more urgent needs (sometimes that isn’t possible due to patients with more severe symptoms registering a need for an appointment).

Sometimes when patients don’t get the answer they are looking for, the staff at Caritas have been met with a “disgusting” amount of abuse, including a death threat.

One member of staff said: “The worst it has been was someone saying they were going to kill me because of an issue with a prescription.

“They stood in the waiting room shouting it at me and stayed there until I finished work, I can remember feeling really nervous with that one.”

Nicola added: “It’s disgusting really, of course it’s a minority (small majority) of our patients, the majority of our patients are lovely, but the receptionists shouldn’t have to deal with that, no one should.

“If any patient is abusive towards the staff now then straight away, they get a written warning and if it continues then they will be struck off. We have struck a couple of patients off in recent times.”

On the day I was in attendance, the surgery in Cefn Mawr had three receptionists, one GP, a GP Registrar, one advanced nurse practitioner, and a practice manager in the building.  The other surgery site had one GP, 2 junior doctors and 2 receptionists.

Patients had appointments with the GP, GP Registrar, and advanced nurse practitioner via face-to-face and telephone calls.

The Leader: Dr Sankey.Dr Sankey. (Image: NQ staff)

With the need to try and ensure patients are seen, appointments are limited to 15 minutes, which Dr Karen Sankey, the sole GP in the surgery the day I visited believes often isn’t enough.

“From 9am until 1pm I had 16 appointments, each one 15 minutes long. Sometimes that’s enough if it’s a less serious complaint or a follow-up review of a patient, but for others who are presenting with new issues or those with complex problems and mental health, you just can’t meet the patient’s needs in that time.

“It leaves you feeling constantly under pressure and if one goes over that time, you’re chasing your tail.

“Once you’ve finished morning surgery you have to sort the clinical admin, signing and issuing prescriptions, actioning test results, actioning clinical letters from specialists and emails, making referrals, and all the other paperwork that needs to be done plus home visits before seeing another 10 patients in the afternoon clinic whilst also squeezing in urgent clinical matters and supporting and supervising the rest of the clinical team.

“There are just no breaks from 8am when you get here to when you leave at 7pm or later, it is just relentless all day every day.” 

As the pressures and workloads increase, more and more GPs are experiencing burnout and sickness, and record numbers are leaving their GP roles or giving up medicine completely, “The job has always been full on, but it’s never been like this, it’s not sustainable”, said Dr Sankey.

Dr Sankey, who has more than 30 years’ experience in General Practice, also revealed that many patient requests involve minor illness and self-limiting conditions such as new onset vomiting, coughs and colds, temperatures, and flu-like symptoms, that could be dealt with elsewhere such as online advice or via a pharmacy.


The Dr added there has also been a stark rise in patients with mental health conditions in recent years.

Dr Sankey said: “Perhaps there needs to be more focus on prevention and education on self-care so patients have more awareness of how to manage minor illness and when they need to seek further advise contact their surgery.

“Primary care is lacking in funding and staff, which in turn means that the demand and work overflow onto the ambulance service, A+E and elsewhere in the system and patients can’t always access the advice and support they require.”

On the other end of the spectrum is GP registrar Alex Hook, who in is third and final year of training works part-time at the surgery.

With a lack of staff, junior doctors across the country are having to take on more workload to help relieve pressures in primary and secondary care, which can sometimes worry Dr Hook.

He said: “It does have its good parts, being in a good team and I do see myself doing it long term.

“I’m getting my fair share as a GP Registrar, which is okay but while in training is that the best way to do it.

“More and more people are needing things, you have people waiting years for services such as hip or knee replacements, so for me it’s about trying to manage expectations of patients getting those surgeries done.

“You then have the winter pressures, which results in the normal demand in clinic plus an additional four chest infections a day.

“We try and use other services to get more people seen, as there are other methods that can best help people.”

Despite the pressures, demands and lack of staff, it appears clear that GP practices are doing all they can to provide the best service to patients across Wrexham.