The threatened closure of Borth GP surgery because of a chronic failure to attract new doctors to run it is a problem not only for its thousands of patients but, by extension, for pretty well everyone else dependent on practices in rural Mid Wales.

As Borth’s one remaining full-time GP, Sue Fish, points out, surgeries in Aberaeron, Cardigan and Llandysul have all been lost in the last 10 years, and Borth now joins that “worrying trajectory.”

But her practice, she says, is in a special category, because it would be the first where there would be no larger surgery to automatically absorb its patients. She identifies practices at Llanilar, New Quay and Tregaron as serving similar sized populations and forecasts they will not survive long “unless things change.”

Without a drawing in of new doctors, the crucial factor will be the ages of existing GPs and how soon they will retire. Dr Fish says she knows of at least two colleagues who have reached retirement age. Relentlessly, that number will be added to.

In Wales as a whole, one in five GP surgeries closed in the last 10 years. In June last year, there were 386 of them - down from 474 in 2012 - a loss of 88 practices.

But, during the same period, the number of GPs in Wales actually rose - from 2,015 in 2012 to 2,301 last year, an increase of 286. Revealingly, government figures show that more GPs in Wales are now working from larger surgeries in bigger towns and cities.

Which brings us neatly to the elephant in the room, the beast that Cardiff-based administrations and governments and Dyfed and Ceredigion health authorities over the last 50 years have refused to acknowledge and which is now dangerously restive.

These bodies have had half a century, and more, to stop the rot of a perilously under-funded and under-resourced Mid Wales NHS. And they’ve failed miserably, and with a still continuing callous lack of remorse, or the slightest intention of a change of direction that recognises, finally, the inherent and obvious demands of a vast swathe of Wales so scandalously deprived of a central and indispensable need - a major regional hospital, in or near Aberystwyth, offering the very fullest range of patient services.

The entrenched South Wales bias of Cardiff-based administrations and governments, and the equally fixed Carmarthenshire bias of Carmarthen-based health authorities, has been, and remains, a killer. To be seen, of course, as part of a chronic and malign pattern of neglect of an entire region of Wales, only the latest example of which is the mere £4.8 million — out of a £1.6billion total — allotted to Mid Wales to improve transport links.

Borth is a quirky little place in a glorious setting with a dynamic GP practice of first importance to people there and in a big surrounding area. But the evidence is that none of that is enough to attract doctors to move there. And this is not surprising.

Generally, high on a list of GPs’ priorities is to be part of a practice which is near a major hospital so they are able to work in close collaboration with specialists and have easy access to the best equipment and widest range of patient services.

Such a critical mass they regard as indispensable for the good of patients and for their own job-satisfaction. Sadly, Bronglais Hospital does not measure up to this prerequisite, despite the devoted and herculean care offered by its staff and the quality of the on-site services it does provide.

Basically, we see that GP-recruitment and sophistication and accessibility of hospital services are inextricably linked.

Throughout the 1990s, and earlier, and later, intense campaigns were fought to preserve the district general hospital status of Bronglais, and to protect and expand its patient services. Always, the campaigners, who included the Cambrian News, met broken promises, and the dead hand of resistance to improvement, from Welsh health ministers, and negativity ranging from non-cooperation to downright obstruction from health authorities.

As ever, a basic requirement now is for the Senedd and the government to radically change the way it sees rural Wales. It must stop seeing it as ‘out there’, removed, on the periphery, with South Wales conurbations the centre of the universe. Current and previous governments would fervently deny this is how it regards that vast hinterland somewhere north of the M4 and south of the A55. But it is.

Rural Wales is generally of as little interest to the Cardiff government as the north of England always was, and largely remains, to Westminster.

When it comes to the NHS, Cardiff’s attitude to a culturally different, geographically distant and seldom visited part of the country translates into the expectation that patients from those blustery outer regions will naturally be expected to gravitate south for much of the treatment much of the treatment that urban patients get on their doorsteps.

This mindset has held sway for far too long. It cannot be allowed to continue. Instead, we must demand one which takes into account a map of Wales and realises that the middle bit is simply so far from major hospitals in the south or north that it absolutely requires its own comprehensive healthcare provision.

‘Hubs’ and ‘spokes’ can crop up a lot when rural healthcare is being talked about in Cardiff and Carmarthen. Hubs will include Carmarthen and Swansea. Aberystwyth will be seen as being on the end of a very long spoke, while Haverfordwest and other NHS locations are on shorter ones.

The government should imagine a bike wheel built like that. It would be impossible to use. And trying to would be extremely dangerous.