HEALTH chiefs agree investment is crucial for the NHS to thrive. In a special report yesterday the Argus revealed the issues crippling Gwent's health service. Today two GPs tell health reporter ANDY RUTHERFORD why family doctors also desperately need a slice of the extra cash announced in last week's Budget

A HEFTY slice of the Budget millions coming to the NHS in Wales must be used to tackle "disgraceful" waiting-times for ortho-paedic patients, says a Gwent GP.

Dr David Bailey (pictured) also believes it would be "absolute madness" if the government and National Assembly do not invest extra NHS cash towards making the new GP contract a success.

Yesterday our special report revealed how Gwent's health service was urgently in need of funding.

Assembly Health Minister Jane Hutt has not yet revealed how much cash Gwent can expect, but health bosses say investment is vital to solve issues including staff shortages and long waiting-lists.

Dr Bailey, based in Trethomas, knows orthopaedic waiting-times are too long throughout Wales - patients in Gwent can wait up to five years for hip and knee replacements and other such surgery after being referred by their GP.

"They can wait three years for an outpatient appointment and one or two years for an operation," he said.

"That's a disgrace. It is a scandalous service for the 21st century."

He said a way must be found to separate routine orthopaedic surgery from acute hospitals, where surgical beds are often filled by emergency medical patients.

Gwent Healthcare Trust is confident of eliminating waits of more than 18 months for orthopaedic surgery by the end of July, but there are still almost 400 in this category.

Across Wales, more than 6,000 people have waited more than 18 months for a first outpatient appointment with an orthopaedic consultant. Gwent's share of this category is well over 1,000.

The trust is considering setting up an elective surgery centre, a proposal welcomed by Dr Bailey.

"But the need is urgent and it takes time to create a centre like that - and of course there aren't enough orthopaedic surgeons," he said.

Dr Bailey, who chairs Gwent's Local Medical Committee, also believes patients will see huge improvements in quality if the new GP contract is backed with funding.

The contract is geared towards allowing GPs to control their workload more effectively, guarding against overwork and making the profession more attractive. It also proposes: *Cash incentives for GPs to improve and widen the services available to patients. * To cut unnecessary demands on primary care.

Further negotiations with doctors and the government will take place before the contract is formalised.

Dr Bailey said: "It would be absolute madness not to put money in to make the new contract work.

"If we are going to put £40bn into the NHS, these services should be funded."

* MORE primary care staff are needed to do some of the work GPs currently have to do - and that means investment in manpower and facilities, says Dr Greg Graham.

A GP who practises in Pontypool and Cwmbran, Dr Graham said money for staff must be backed with money for facilities, as many surgeries do not have the space to house more staff.

"There will be many in Gwent who could not possibly do that, because some GPs work in particularly cramped circumstances," he said.

"Often, those of us in primary care have the know-how but not the time and the facilities. Patients are often bounced backwards and forwards like a yo-yo between surgeries and hospitals. Perhaps if we had the time and facilities, many patients might not need to go to hospital in the first place.

"But the real problem is manpower. If somebody threw tens of thousands of pounds at me and said employ more staff, even if I could find them I would most likely be taking them off someone else.

"There just aren't enough trained people around and GPs and primary care staff are being overworked. Along with that goes stress and poor morale, and people often quit or go part-time.

"We also need to make sure conditions in primary care in Wales are as attractive as those in England. Wales has always been an area from which there has been medical emigration."

But all the necessary changes will take a long time to implement, says Dr Graham.

"Training new GPs and nurses and the like, and funding new facilities, does not happen overnight."