4. Will the Minister make a statement regarding the share of resources between primary and secondary care? OAQ(5)0061(HWS)

Thank you for the question. I expect resources between and within primary and secondary care to be used to address the health and well-being needs of the populations that each health board area serves. I expect resource use to both lead and follow the changing pattern of services as more care is delivered closer to home.

Can I thank the Cabinet Secretary for that response? But the share of the Welsh health budget spent on primary care has reduced over recent years. Is there any intention from the Welsh Government to try and reverse this trend, because I believe, and I hope the Cabinet Secretary does, that spending money in primary care saves money further along the line?

Thank you for the point. I think part of the challenge in understanding what’s happening in primary care is understanding what we mean by primary care spend, as well. I’ve seen a range of figures. There’s obviously campaigning, lobbying and, quite rightly, scrutiny about the amount of money that we spend and the share of money that we spend. For example, we spend in primary care spend 13.7 per cent of our budget, compared with Scotland spending 11.8 per cent. That’s drawn from comparative figures that the Royal College of General Practitioners in Scotland accept as properly representing primary care. So, it isn’t just a general medical services spend.

I think, though, that rather than getting lost in talking about a set percentage of the health budget or a set sum of money, we need to be focused on what is our vision and expectation for the future of healthcare services. How will they be delivered? If more care is going to be delivered within the community and closer to home, we need to shift our resources. Those resources are in some parts financial, but, actually, a lot is about the staff that we have and the way that we use and remodel our primary care estate to be able to deliver that service. I’m interested in delivering the right service, in the right place, at the right time and having resources that enable us to do that. That will see a shift in resource. That’s where my priority is, rather than having a set point at which I say, ‘I want x amount to go into primary care or secondary care,’ because I don’t think that’s necessarily the right way to run and manage the service.

The Deputy Presiding Officer (Ann Jones) took the Chair.

Cabinet Secretary, community pharmacies have a big role to play in delivering care in the right place at the right time, as you just talked about. I had the chance, recently, to visit a Lloyds Pharmacy in my constituency. I was struck by the disjoint between hospitals and community pharmacists when it comes to discharge. Although discharge medicine reviews do happen, I understand that 30 per cent of hospital readmissions are down to medicine errors. Is this an area the Cabinet Secretary will be looking at in the current negotiations he’s having with Community Pharmacy Wales around a new pharmacy contract for Wales?

Thank you for the question. It allows me to highlight work that is already ongoing. Of course, I’m sure you will appreciate, and the pharmacy you visited will appreciate, that we are taking a very different approach to the funding of community pharmacy here in Wales, compared with the £200 million cuts being delivered to pharmacy in England. It’s a real challenge for community pharmacy over our border. I am pleased we’re taking a different approach, not just on the money, but on what we expect to see delivered for that money as well, because we will have a quality-based approach with that extra sum of money that we are saying we will continue to invest in community pharmacy. It will change not just dispensing against the amount of items, not just volume, but actually the quality of the service as well. I’ve already asked for a piece of work to be done with community pharmacy—it’s being led by the chief pharmaceutical officer—on looking at a specific range of areas, and actually understanding how we improve the hospital discharge process is a specific part of that work, and I expect to see proposals for improvement. I think we can make greater use and greater benefit from the quality of services that exist within community pharmacy to make things easier for patients who leave the hospital and then go back into their community, and, at the same time, we’ll certainly have a very busy hospital pharmacy service as well. So, over the course of the next six months or so, I think we’ll hear more from me about how we’ll continue to develop and invest in community pharmacy here in Wales.

You made that announcement last month of £20,000 to attract new junior doctors to work in general practice in areas of Wales where it’s difficult to attract doctors. Naturally, we welcomed that, but it does nothing for the huge pressures on GPs currently in post this afternoon, in all parts of Wales if truth be told. So, what about vireing some resources and funding to primary care now in order to assist those GPs currently working, as well as attracting future GPs?

Thank you for the point, and it’s one that is well understood. Part of the work we’re doing on the ministerial group that I’ve convened and I’m chairing is to look at both the points about new entrants into the profession as well as supporting the people currently in it. So, this isn’t a point about ignoring people who are currently working within primary care. So, the incentives were specific to deal with and address areas of need. We’re listening to our partners around the table, and it’s all partners—a range of health professionals, including, of course, the British Medical Association and the Royal College of General Practitioners—to think about how we better support our current practices. There’s something about the cluster money that is already there, and making sure it gets out to practices so they can use it and determine how they want to use it with their partners within primary care. There’s also something about looking again at the sustainability framework and understanding what we need to do to actually make sure that more practices engage in that. Because we have found that not every practice that is facing a challenge is prepared to go through that process where extra help can be provided. I think there’s something about the level of trust and information sharing to allow that support to be provided. So, there’s more work for us to do, and it’s actually an opportune time to be talking about this because, of course, we’re starting negotiations with the BMA on the future of the GMS contract here in Wales. So, plenty of opportunity, both in the contract negotiation, but also with the work that we are doing to try and improve the numbers of people, but also the range of people within the primary care workforce.

I’d just like to pick up on the point made by Nick Ramsay because it’s completely unacceptable that a third of all hospital readmissions are due to medicine errors. I want to probe a little bit further on the specific point that when it’s been decided that somebody is ready to leave hospital, why is it not possible for them to then pick up the prescription that they may have been prescribed from their community pharmacist, rather than having to wait for it to be dispensed by the hospital? Because that would then enable them to get out of hospital quicker, making them get well quicker, and making the bed available for somebody else.

It’s part of the work that I expect to see undertaken because I think the ideal thing would be for people to be able to have that medication, wherever possible, delivered by or with their community pharmacy, whether it’s about collecting or about a home delivery service. The great majority of community pharmacies do provide that form of service. I think it would help in seeing people leave the hospital when they’re fit for discharge. It would also deal with some of the delays within the hospital pharmacy service that we know take place as well. So, people that really have to be seen within a hospital pharmacy setting should get their medication more rapidly, as well as it allowing people to leave. So, it’s absolutely a part of the work that I’ve asked to take place and, as I say, I look forward, over the next six months or so, to reporting back to Members on the progress that is being made.