Developing a co-operative response to the primary care crisis in Wales
Primary care in Wales is at a breaking point and we need to work together to develop solutions to this crisis. GP practices across the country are under unprecedented strain, with rising demand, falling workforce numbers, and growing financial pressure threatening the sustainability of services that communities rely on every day.
BMA Cymru Wales has described the situation facing GP practices as “unsustainable”. Over the past decade, GPs in Wales have been expected to care for significantly more patients while the number of full-time GPs has fallen sharply. Nearly a fifth of practices have closed, workloads are routinely unmanageable, morale is low, and many experienced GPs are planning to leave the profession in the next few years. At the same time, the proportion of the NHS Wales budget invested directly in General Medical Services has fallen, placing further strain on already fragile services.
If we are serious about protecting access to primary care in Wales, we need to move beyond short-term fixes and explore new, sustainable models of delivery that work for patients, professionals and communities alike. Wales has led the way by innovating in health before, and by taking a co-operative approach we know we can do it again.
Why the current model is no longer working
Historically, GP services in Wales have been delivered through small partnerships or sole-trader models, with individual GPs holding personal responsibility for running practices under contract to local health boards. As GPs retire, fewer new doctors are willing to take on the financial risk and personal liability that comes with this model.
The response so far has often been consolidation – asking neighbouring practices to absorb additional communities – or bringing services in-house under direct health board control. While these approaches may keep services running in the short term, they do little to address the underlying workforce, sustainability and community engagement challenges facing primary care.
A co-operative solution: community health co-operatives
Community health co-operatives offer a different way forward. Set up as community benefit societies, community health co-operatives would remove the need for individual GPs to carry personal liability, while embedding primary care services more deeply within the communities they serve. Instead of being owned by a small number of partners, the service would be owned collectively, with democratic control and a clear social purpose.
Crucially, these co-operatives could be multistakeholder by design. Membership could include:
- Patients and local residents
- GPs and other health professionals
- Practice staff and wider workers
- Representatives from local authorities and health boards
- Community-owned organisations delivering health and wellbeing services
Each member would have an equal vote, and the board would be elected to act in the best interests of the whole community. As a corporate body, the co-operative could then contract with the local health board to deliver primary care services.
Any surplus generated would be reinvested back into frontline services, preventative activity, and wider community wellbeing – not extracted for private gain, as is increasingly happening in Welsh communities.1
The co-operative difference
A community health co-operative model has the potential to deliver benefits well beyond keeping GP surgeries open.
Supporting the workforce
Co-operative models give workers a greater voice over how services are run, which is consistently linked to improved job satisfaction and retention. By supporting multidisciplinary teams, co-operatives can reduce pressure on GPs while delivering more holistic care. Most importantly, the model creates long-term stability, ensuring practices are not dependent on individual owners and can continue even as staff change.
Financial and operational sustainability
As non-profit organisations, community health co-operatives would reinvest resources locally, strengthening services rather than draining them. Their structure also supports a stronger focus on prevention and early intervention, reducing demand on acute services over time.
Stronger community engagement and trust
By giving patients and communities a democratic stake, services become more responsive to local needs. This approach can help tackle health inequalities, ensure underrepresented voices are heard, and rebuild trust in primary care services that many people currently feel are overstretched and inaccessible.
Wider economic and social value
Community health co-operatives keep NHS funding circulating locally, support local employment, and can link closely with social enterprises addressing the wider social determinants of health – from housing and mental wellbeing to social connection.
Learning from elsewhere
This is not an untested idea. Internationally, cooperative and community based health models operate successfully in countries such as Spain, Italy and Canada, where health cooperatives have demonstrated strong patient satisfaction, resilient workforces and improved integration with community services. Closer to home, Wales already has a strong track record of community-led models in housing, social care and energy – providing a solid foundation to build on in primary care.
Listening to the experts
This approach also aligns strongly with the Bevan Commission’s Health Matters manifesto and the widely accepted principles of Prudent Healthcare, particularly the emphasis on co-production, prevention and doing things differently with communities rather than to them. A multi-stakeholder community health co-operative is a practical way of turning these principles into reality in primary care.
Similarly, the BMA Cymru Wales manifesto focuses on workforce pressures, sustainability and protecting patient care, and a co-operative model offers one potential route to achieving many of those ambitions in practice – by removing individual liability, strengthening multidisciplinary and co-production ways of working, and nurturing a model that can help to create long-term organisational stability for GP services.
What Wales needs next
Developing community health co-operatives will not happen overnight. It requires investment in community development, specialist advice and patient, place based piloting. Communities would need support to explore interest, form steering groups, establish governance, and develop viable business plans capable of contracting with health boards.
But this investment would be modest compared to the cost of ongoing GP closures and crisis management, would mitigate the risk of profit extraction – and the long term returns for health, wellbeing and resilience could be transformative.
A call to political parties ahead of the 2026 elections
As Wales approaches the 2026 Senedd election, political parties have a crucial opportunity to show leadership on the future of primary care. We believe all parties should commit in their manifestos to exploring and piloting community health cooperatives as part of a wider shift towards preventative, community led health services.
At Cwmpas, we set out a clear vision for this approach in our manifesto for the 2026 Senedd election, which calls for greater use of cooperative and community owned models across the economy – including health, social care and wellbeing services.
By embracing community health cooperatives, Wales has an opportunity not just to stabilise GP services, but to reimagine primary care as something owned by, accountable to and rooted in the communities it serves. Now is the time to be bold, collaborative and cooperative.
