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Dr Arfon Williams, GP and team, Ty Doctor, Nefyn

Betsi Cadwaladr University Health Board


Dr Arfon Williams was left as the ‘last man standing’ at a primary care practice in Nefyn, caring for 4,500 patients over two sites. The GP surgery was topping the charts for all the wrong reasons: named as “most likely to fail in North Wales” by a senior Health Board member.

Dr Williams had a choice: calling it a day, handing back the keys to the Health Board, risking bankruptcy and the job security of his staff; or finding a new way to provide a safe, comprehensive service to patients. He chose the latter.


The team decided to change their way of working by triaging and signposting all phone calls and upskilling their staff. They communicated these changes to their patients, emphasising that they were being made with the sole intention of improving capacity in primary care.

The project aimed to put existing staff to better use and changing the skill mix of the practice to enable a sustainable workload.


The challenges facing the project were immense: the team needed to fundamentally change the way it worked, from answering the phone to liaising with patients. Team members explained to patients the rationale behind implementing these changes, and asked them to be understanding in this new mode of working. Other issues included loneliness and lack of wider support in having to face these challenges.


A key outcome of the project is that patients are very happy with the service they receive.  They are able to pre-book appointments and the surgery also allows on-the-day appointments.

Other benefits include happier staff with better morale, in that there is always a solution to offer the patient. Patients are also satisfied that they get their problems dealt with by a suitably qualified clinician in a prompt manner (usually within 24 hours).

Next steps:

The next steps for the project are to scale-up and try and spread the message of how it has changed working practice. The project team has received offers from the RCGP to facilitate workshops both in Wales and England, and is working closely with the Bevan Commission and the Welsh Assembly Government to try and scale this up more locally.