3. What work is being undertaken by the Minister to attract doctors to Wales? OAQ(5)0050(HWS)

Thank you for the question. As I made clear in my statement to the Assembly on 20 September, we will be launching a national and international recruitment campaign on 20 October to market Wales and NHS Wales as an attractive place for doctors to train, work and live.

Doctor shortages affect all areas throughout the country, as we’ve already heard, but, in the Rhondda, we’ve got a particularly acute problem, which has led to Cwm Taf university health board setting up a website specifically to attract doctors to our area. Even though you are still in denial as to what the statistics say, as we saw just now in your answer to my colleague, Rhun ap Iorwerth, the number of hospital doctors employed by Cwm Taf declined by 44 between 2014 and 2015, which is, of course, the last date when we have figures available. This is a staggering loss for just one year. The number of hospital doctors employed by Cwm Taf is now lower than it was in 2009. You’ve said previously that this is a record number of doctors. Is this what a record number of doctors looks like in the Rhondda? Do you now regret making that statement to me earlier on this summer, or are you still in denial?

This isn’t a question of being in denial, and there’s a challenge for us about how we talk about health and social care in a grown-up manner in this Chamber, and how we understand what we need to do to improve outcomes for people receiving care and improve—not just increase the number—the way that the workforce is organised.

I’m really pleased to recognise initiatives that doctors in the Rhondda are taking. I think that the Rhondda Docs website is an excellent initiative for Rhondda doctors, and it’s a positive message about what it means to live and work in the Rhondda and what they’re actually doing. For example, their most recent recruits talk about what they’re doing and they talk about where they save time, both for patients and for doctors.

I really do think that there’s a balance here between saying, ‘How do we hold the Government and the health board to account? How do we ask difficult and awkward questions as part of what we do?’ and, at the same time, ensuring that we don’t simply say, ‘Everything is awful and nothing is changing’. I’m actually positive about where we are, because we’re recognising the challenges that we have. We’re recognise the picture that we face and we recognise the areas where there’s a real challenge in changing the areas in which the service is organised from primary to secondary care, within primary and specialist care, and what we need to do to have the best possible chance of attracting people to come to Wales to train, to work and to live.

I’m looking forward to the next stage of our campaign. I look forward to coming back to this Chamber in years to come to look at what we’ve actually managed to achieve and to say honestly where we’ve been successful working with our partners, and, equally, to recognise what more we still need to do. Every year, we’ll know what we need to do in what is a remarkably difficult recruitment market and a remarkably difficult position across the UK, bearing in mind the picture of public services and the rhetoric of the UK Government that will affect us, too, when it affects other people who ask, ‘Do I want to come and work within a healthcare system where the message of the UK Government is that you’re only welcome for a certain period of time?’ We will still be reliant on international recruitment as well as doing more of what we could and should do to make sure that people within Wales and the UK have a real career and a real stake in medical education, training, living and working as doctors in our country.

As well as timely access to a GP, I’m sure that the Cabinet Secretary will agree that fair access is also vital. Is he aware of a pilot programme operating in England where patients are actively encouraged to pay to jump the queue for an NHS GP appointment? Would he agree with me that that kind of practice has no place in the NHS here in Wales?

I thank the Member for the question and for highlighting the issue. I understand that the company is called Doctaly and it’s operating around the London area, but they’re looking to expand. I absolutely share your sentiment—I don’t think that this has any place in the health service here in Wales. It would not be something that we would fund or encourage here in Wales. We believe in a public service ethos for our health service here in Wales. We are supporting core values and principles for staff across the piece, and there is no way that I would encourage or support such measures to take place here in Wales. Our challenge is how we improve the service for the whole population, not how we give an advantage to people with money to take further advantage of a system that is here to serve all of us.

Cabinet Secretary, the old primary care model is not so attractive to many young doctors, particularly the high capital cost, for instance, that they have to commit to in a partnership. Also, many young GPs want to carry through to a level of specialism and, again, unless there are larger practices, this can be very difficult. It seems to me that these two areas are rich in opportunity to develop here in Wales and make it particularly attractive to GPs.

I think that those are completely fair and reasonable points to make. We recognise that the older model may work for some people, but there are different doctors with different priorities—a change in the workforce and a change in what people want to do. For example, it isn’t just that there are more women who are doctors—actually, men who are doctors want to spend more time with their families as well. So, you see people who think that it’s important that they’re around as their child is growing up, and that that, actually, perhaps, if you go back 50 years, might not have been the priority. So, understanding how and why we change the model really matters.

It’s not simply about cutting our cloth against the money. It’s actually about saying, ‘How do we improve outcomes for people to make sure that it’s a more attractive place for people to live and work in the country?’ I’ve said before in this Chamber, and have had some criticism from some Members, that the future of primary care will almost certainly be a smaller number of organisations—amalgamations and/or federations—where there should be more potential to still provide a local service with doctors who people know and trust, but that will provide different services to shift more care into the primary sector.

A really exciting and positive step forward, I believe, is the federation that’s taking place within one cluster in Bridgend, where doctors have come together. They’ve formed their own not-for-profit model to understand how they can run and manage their service in a more holistic way. That should make it easier for new doctors to come in, not having to buy into a property, and to understand what those partnerships will look like in the future. There are questions for us about how we use capital funding to renovate the primary care estate and what that then means for the people working in that service and providing and delivering what I hope will be an expanded and more diverse service that still meets the needs of people in every community up and down the country.