When members of Hywel Dda University Health Board gather at Yr Egin in Carmarthen at 9.30am on Thursday 28 May, they will not be asked to do what they were asked to do in January.
The Vacant Practice Panel’s original recommendation — that all 4,350 patients of Meddygfa’r Sarn in Pontyates be dispersed across neighbouring practices and the surgery closed — still exists. It has not been withdrawn. But thanks to four months of sustained campaign pressure and a string of damaging disclosures about the evidence base, the board will instead be asked to begin a procurement process to test whether an independent contractor will take on the GP contract.
It is a significant shift. But it is not a reprieve. If procurement fails to find a viable bidder, the original closure recommendation is still in the room.
The story that almost happened in silence
When Swansea Bay News first reported on 22 January that the future of Meddygfa’r Sarn was in doubt, the proposal to close the surgery had attracted no significant public attention. Most of the surgery’s patients had no idea their GP service was about to be dispersed.
Jane Nicholas, speaking on behalf of the Save Meddygfa’r Sarn Working Group, reflected this week that the closure could have gone ahead largely unnoticed had it not been for that initial report.
What followed has been one of the most sustained and detailed community campaigns this part of west Wales has seen in years. Patients launched petitions. Councillors demanded action. The board agreed an eight-week consultation. Lee Waters, then Llanelli MS, raised the alarm over fears the surgery was being wound down. The campaign petition to the Senedd passed 1,000 signatures in under three weeks — and patients formed a human chain around the surgery building in a ‘Cwtsho’r Sarn’ solidarity event, drawing hundreds of protestors.
What the board was told — and what the evidence showed
Through it all, the working group was doing something else: it was lodging Freedom of Information requests. And what those requests uncovered became the most uncomfortable part of the entire process for Hywel Dda.
The group’s 12-point analysis, published in May, set out a consistent pattern: a board that had been given a selective and incomplete picture before being asked to approve closure. The issue, the analysis concluded, was not that the information presented was false — it was that key context had been omitted, alternatives had not been explored, and risks had not been fully assessed.
On the building. The board was told the premises were not fit for purpose, citing flood risk and space limitations. The FOI documents showed 82% of the building had been rated satisfactory or better, with a projected lifespan of around 40 years and backlog maintenance costs of approximately £94,000 over ten years. No alternative premises had been explored. No relocation feasibility assessment had been carried out. No comparison had been made between upgrade and closure costs.
On the workforce. The board was told the practice was entirely locum-dependent with no Clinical Lead and no salaried GPs. The FOI documents showed that the same locums had been working at Meddygfa’r Sarn for years, providing what the health board’s own records described as continuity of care. The surgery has been without a salaried GP since February 2025 — but no targeted recruitment campaign had been run for the surgery specifically in nine years. The case was framed around symptoms, not the absence of effort to address them.
On the finances. The board was told closure would cost an estimated £131,000 plus IT and support payments. What it was not told was the cost of any alternative — because none had been calculated. No comparison with other practices. No cost-per-patient benchmarking. No financial modelling of a merger, a refurbishment, or sustained recruitment.
On performance. The board heard about governance concerns and prescribing risks. It did not hear that patient satisfaction stood at 8.02 out of 10, that 74% of patients were satisfied with access, that staff appraisal compliance was 100% and core training compliance 95.3%.
On patient impact. The board was not given a travel time analysis. No equality impact assessment. No rural deprivation analysis. No safeguarding plan for vulnerable patients. The full Equality Impact Assessment was only completed in April 2026, three months after the original recommendation — and only after patients at the Pontyberem drop-in event in March explicitly demanded one.
On clinical risk. The Clinical Assurance Framework inspection — the formal governance review — had not been completed at the time the closure recommendation was made.
On strategy. While the board was being asked to close Meddygfa’r Sarn, Hywel Dda’s own new strategy, “A Healthier Mid and West Wales”, was telling patients it would deliver “more care closer to where you live by providing services in the community first” and that where services changed location, the board would “make sure they remain safe, sustainable and based on clinical standards.”
On alternatives. Hybrid models — retaining Meddygfa’r Sarn with a shared workforce. Targeted investment. Phased improvement. Enhanced recruitment. Community-based redesign. None of these had been meaningfully explored in the case presented to the board in January.
Hywel Dda’s own April 2026 Equality Impact Assessment — produced after the FOI material had become public — scored the impact of dispersal on older people, disabled patients and those facing socio-economic deprivation at -9 out of a possible -25. That is a moderate negative impact, rated as likely to occur.
The six questions Hywel Dda has not answered
On 12 May, Swansea Bay News put six detailed questions to the health board based on the FOI analysis. The questions asked whether the correct process had been followed, whether equality assessments and travel time modelling had been completed before January’s meeting, and whether the board had a full and balanced picture of the evidence before it.
The health board asked for an extension until its board paper was published on 21 May. The response, when it arrived this afternoon, pointed us to the published board paper and to a corporate press release in which Chief Operating Officer Andrew Carruthers thanked everyone who had shared their views during the engagement period.
None of our six questions were answered directly.
957 voices
The engagement period that followed the board’s January decision was extensive. By the time it closed on 6 April, 957 patients had completed the questionnaire — supplemented by six emails, four telephone calls and three letters. More than 350 people attended three public drop-in events held in Pontyates, Pontyberem and Carway.
The feedback was overwhelmingly negative. Transport was the dominant concern at every event. Of those who responded to the questionnaire, 21% currently walk to Meddygfa’r Sarn. Around one in three respondents identified as disabled. A return taxi from Pontyates to Pontyberem was quoted at around £15. Some patients described bus journeys that would require travelling first into Carmarthen and then back out — a process that could mean waits of up to 90 minutes at the bus stop.
The Pontyates event, on 24 February, attracted 215 people. Carway, added only after councillors pushed for a third event, drew 89.
The health board has costed a community transport service through Dolen Teifi at between £19,000 and £85,000 a year, depending on hours and vehicle type. What it has not costed, despite repeated campaign requests, is the alternative — investment in the existing surgery and a sustained recruitment campaign for a salaried GP.
The campaigners’ view
Clare Treharne, who leads the working group, said this week that the FOI evidence raised serious concerns about whether the original closure recommendation was fair, balanced, or fully informed. The case for closing the surgery, she said, was built on selective information with key evidence missing or incomplete.
The working group has submitted a 52-page report and a separate sustainability document to the health board ahead of Thursday’s meeting. A clinical team — understood to comprise a GP and a pharmacist — has separately submitted a bid to take over the running of the surgery.
The group’s other prominent spokesperson, retired nurse Janet Knott, served the NHS for 52 years, much of it in the Gwendraeth valley. She has warned that the dispersal plan would place enormous strain on receiving practices that are already overstretched.
The political dimension
The story has crossed every party line. Independent Senedd candidate Carl Peters-Bond joined the campaign in April. In May, the independent candidate and surgery patient called on Hywel Dda to scrap the closure plan following the FOI revelations. The Green Party candidate called for an independent review of the process, citing the missing equality assessment.
Local councillors have issued a joint statement calling for any decision to be postponed, saying that, as local representatives, they have no confidence in the process Hywel Dda has conducted. They have called on the board to put patients before savings.
Campaigners have also written to the six newly elected Senedd Members for the Caerfyrddin constituency, requesting a meeting to put last-minute pressure on the board. First Minister Rhun ap Iorwerth, interviewed on the BBC the day after being sworn in, pledged that his government would prioritise primary care and redress the funding imbalance that has grown in recent years.
What the board will be asked to do on Thursday
If members agree to the procurement route, a new Vacant Practice Panel will eventually be convened to consider the outcome of that process and make a fresh recommendation. The board paper proposes skipping reconvening a Vacant Practice Panel before procurement begins, in the interests of expediency.
Hywel Dda’s recommendation is that board members:
— note the feedback from the public engagement period
— note the informal expressions of interest received during the engagement period
— agree that a procurement process should be undertaken to test the feasibility of an independent contractor taking on a GMS or APMS contract for Meddygfa’r Sarn
What the recommendation does not propose is the option many in the community have been asking for from the beginning: a proper, targeted, sustained recruitment campaign for a salaried GP at Meddygfa’r Sarn, supported by investment in the existing building.
The Public Board meeting takes place at Yr Egin, Carmarthen, from 9.30am on Thursday 28 May. It will be broadcast live on Hywel Dda’s YouTube channel. Campaigners are urging supporters to attend in person. Further information is available from the Save Meddygfa’r Sarn Working Group at admin@saveoursurgery.uk.
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As a member of the Save Our Surgery Committe, I cannot thank you enough for the support we have received from you in this campaign. The first we heard about it was in Swansea Bay News, no-one from the NHS had told patients ot staff anything. It’s great to see the press doing it’s real job and holding people to account and supporting people power.