I’m slightly diffident in rising to speak on the topic of the integration of health and social care, given the immense contribution that my predecessor as Assembly Member for Neath, Gwenda Thomas, has made in this particular policy area in Wales, and in particular with regard to the Social Services and Well-being (Wales) Act 2014 itself. So, I’ll take this opportunity to pay tribute to her for her political legacy in this place, which will surely benefit hundreds of thousands of people in Wales.

Like many Members, I’m sure, access to a GP is something that came up routinely on the doorstep during the election campaign we’ve just fought, and it still does. One issue it seems to me important for us to recognise, as Dai Lloyd already has, is that the increasing numbers of older people that our NHS and care services need to provide for is the result of improved healthcare provision over the years. And, in that sense, it’s a result of success. I am always mindful of the language that we use when we speak about the needs of older patients in describing the challenges facing health and social care. We would all agree that it is unequivocally a good thing and a thing to be celebrated that we have a generation of older people living longer whose needs we’re able to cater for.

But the operational challenges of addressing this need are another matter, and we do need more GPs in order to meet the needs of our population, and this is, and must be, a priority for the Government. But, actually, the overriding aim must be a primary care service that provides the right sort of care, whether that’s provided by a GP or another health professional perhaps better equipped to do that. The development of multidisciplinary practices with pharmacists, practice nurses and other professionals working alongside GPs offers the potential to provide the type of care required by the patient whilst also enabling the GP to focus on patients who have a particular clinical need to see a general practitioner. I’d refer to the excellent model of innovation in the Amman Tawe practice in my constituency, which also extends into the Carmarthen East and Dinefwr constituency of Adam Price. It seems to me that a strong practice ethos and parity of esteem between practitioners is vital to the success of that model, and the prize is not only care that better meets the needs of the population, but perhaps it also makes it easier to attract GPs to those practices. I stress that this isn’t to deny the fact that we need to recruit more GPs. We clearly do, and we need to continue to help those practices that are finding it hard, for whatever reason, to fill those vacancies.

One of the key issues, it seems to me, is that the reconfiguration of those practices is one part of the equation. But the other vital part is the role and in particular the expectations of the patient. It may be understandable for a patient who has been, over the years, used to seeing a GP to feel that seeing another healthcare professional doesn’t do the same or indeed a better job. Many of us will have examples of concerns raised over triage arrangements in particular. So, it seems to me vital that ways are found to engage local communities genuinely and deeply as partners in improving health and care provision. There is a relationship of trust at the heart of the doctor-patient relationship that is not straightforward to replicate. But, equally, successful multidisciplinary arrangements seem to me to depend on a good level of health literacy in the general population. There is an element of physical and mental self-awareness and an understanding of risk that perhaps isn’t where it needs to be in order for some of these practises to work in the best way. So, the work that Public Health Wales and others do in striving to improve health literacy is crucial.

I want to say something about the relationship between public transport and primary care services. The work done by the Government’s bus advisory group acknowledges the importance of aligning routes to key trip generators like health centres. We should also explore the potential for primary care centres themselves to partner with volunteer-based regulated community transport providers to make it easier for patients to access appointments. Indeed, we should also look at how primary care practices can be supported generally to work more closely with the voluntary sector as equal partners, which Sian Gwenllian alluded to in her contribution. A community level focus on this is important. Getting this right will support the integration of health and social care at a primary care level as well as at a secondary level, and care planning needs to focus on the holistic needs of the patient, taking into account the role of social services in the community and indeed the role and, in fact, needs of carers themselves. As many speakers have mentioned, there are excellent examples of this across Wales, and the intermediate care fund exists to support that way of working. But we must ensure that in this, as with other areas that I’ve mentioned, best practice is identified and universalised.