I thank Julie Morgan for the series of questions and the examples she gives from her own constituency of Cardiff North. I’ll start with the point you make about the position that Cardiff finds itself in, which is different to lots of other parts of Wales. It is an expanding city: that is a positive thing but that does bring different challenges. It’s why I’m careful, when other Members urge me to accept that the biggest challenge is always in providing rural healthcare, that we say that we have to accept that the context in which healthcare is provided differs and there are particular circumstances—I always get different versions of ‘treat me fairly’, whether it’s rural representatives saying there are different challenges in rural parts of Wales, or the city of Cardiff having particular challenges, or that there are Valleys communities that have particular challenges as well. It’s about how we appropriately and properly address those, and we have a fair way of actually understating how extra funding is allocated, but also actually about how we attract people into different parts of our country to work, because some parts of Cardiff are more attractive to work in than others as well. So, within the city there are different challenges as well as those challenges outside. But it is a point well made that we do need to consider those in our particular policy prescriptions and responses.

I’m really pleased to hear her refer to North Cardiff seeing, if you like, the whole patient in terms of their social setting and their family setting and to understand what matters to them and what’s important to them, because people with similar conditions may want different responses. There are different levels of risk people are prepared to take in what they do and don’t want to do and how they’re actually able to cope and manage. So, it’s really encouraging to hear that conversation taking place. We need to see more of that and actually the patient being properly engaged in having a conversation with the medical professional about what matters to them, what they actually want to achieve and how the healthcare choices for treatment are then made, as well as prevention.

In terms of those other issues that may have an impact on someone’s health, we know that a range of GPs are being more proactive at understanding where and how to refer people to other sources of help and advice. Other fields of their lives may be affecting them and they may actually present at a GP practice with a healthcare need when actually it’s a different sort of issue that needs to be addressed and resolved—benefits issues, for example, are ones where we know that there is a range of GP practices involved. I met one just a short distance away from here that has a very proactive arrangement with Citizens Advice, for example. That proper referral process has been really helpful to them in knowing where and how to send people.

That also leads into your point about the primary care estate and how we build it. It’s not just the Bromley by Bow Centre, there is a range of other examples of where how you design and deliver a GP practice can help to set the context in which that healthcare is delivered, and how you properly link in other parts of not just the life of the patient, but also the practice and how it sees its actual mission in providing healthcare to its community.

That again goes back to your final point about the experience within training and what happens when people are studying medicine. For example, the Cardiff course is different, it’s an undergraduate one, to the graduate entry in Swansea, but I’m encouraged by the initial feedback from both Cardiff and Swansea regarding the numbers of people who train there who choose to make their career in Wales afterwards as well. They both have good records of not just bringing people to study medicine here in Wales, but of keeping them here as well. What we want to try and learn and understand, in looking at medical education and training in the future, is what more we can do to make sure that the experience is a rewarding one, that primary care is properly held up as a genuinely rewarding career and that the experience helps you to be a fully formed professional, not just to understand, if you like, the technical sides of medicine, but that point about seeing the whole patient and understanding how you help them to make choices for themselves to have a genuinely rewarding experience.