[R] signifies the Member has declared an interest. [W] signifies that the question was tabled in Welsh.

I now call on Mark Isherwood to ask the second urgent question.

Will the Minister make a statement on Ruabon Medical Centre in Wrexham, which has ended its contract with the NHS after being unable to fill two vacant doctor posts? EAQ(5)0095(HWS)

I haven’t actually got the wording, but will the Cabinet Secretary make a statement in relation to the announcement of a GP closure in Wrexham?

The Ruabon surgery has given notice to the health board that it will terminate its contract on 31 March 2017. The health board, which is responsible for the provision of healthcare services, has written to patients to assure them that the surgery will not be closing, and services will continue.

The Member may ask a supplementary in a moment. If a question is urgent, it should be asked in an urgent way, and I expect Members to be ready to ask urgent questions next time. But ask your supplementary.

Thank you for that, and I apologise. This surgery, the Ruabon Medical Centre, is only the latest to announce that it will be ending its NHS contract with the health board because it’s unable to fill two vacant doctor posts. Last month, it was the Rashmi practice in Colwyn Bay. Over the last year, we’ve seen the same in Prestatyn, Rhuddlan, Wrexham, Conwy, and the British Medical Association’s Dr Charlotte Jones, general practice committee chair, has said:

‘Surgeries handing back their contracts to the health board is a real time demonstration of how some general practices are at breaking point and see this as the only solution open to them.’

The north Wales local medical committee warned at a meeting in the Assembly in June 2014 that general practice in north Wales was facing crisis, with several practices unable to fill vacancies, and many GPs considering retirement. Early this year, GPs in north Wales wrote to the First Minister, accusing him of being out of touch with the reality of the challenges facing them. How, therefore, do you respond to the concern expressed by the Royal College of General Practitioners in the Assembly in June this year, that the multidisciplinary team model being introduced instead in north Wales by the health board is needed, but it’s based on an overseas model with a higher ratio of GPs to other disciplines, and that it will lose the holistic view and continuity provided by GPs, damaging the well-being of patients, and that the health board needed to step up in times of—should step up—shouldn’t wait for a crisis to step up? It should have stepped up well in advance, as should the Welsh Government, given the years of warnings it has received.

Thank you for the question. There are a number of practices that are in the direct management of health boards. It represents less than 5 per cent of the total number of GP practices, which is comparable with the situation in Scotland. There has been a small increase over the last year or two. We recognise there are very real challenges for the future of primary care, and we recognise that, alongside both the BMA and the royal college of GPs, there will need to be a change in the way that primary care is delivered in the future. That’s why we have a model of clusters, bringing together practices to support each other, to work with other members of the wider primary care team—pharmacists, therapists, and social care and other partners, too. We recognise there are significant challenges that are out of our hands. The pension changes, for example, are seeing a number of GPs think about leaving the practice earlier. That’s why we’re happy to work alongside our colleagues in primary care. It’s why we have a ministerial taskforce aimed directly at improving the offer for GPs within Wales as part of a wider team. It’s why I’ve had a very successful engagement with both those partners and the wider group of primary care professionals.

There is nothing complacent about this Government. We recognise that primary care needs to change and we want to work with partners to deliver that to make sure people receive high-quality primary care. It will be organised and delivered in a different way, but the main point is, it will be high-quality primary care to help people meet their healthcare needs, and, hopefully, to help more people avoid long-term health conditions in the future as well.

I note that patients have been contacted to put their minds at ease that the practice is not at risk of closure. But people are very, very uneasy, the length and breadth of Wales, as surgery after surgery hands back the keys or have their contracts ended. As in Ruabon, what we see in many other places is a failure to be able to recruit the adequate number of GPs to keep a practice going, and that’s why we need to face up to the crisis in training and recruitment and retention of doctors in primary care with much more urgency than is certainly currently the case. I’m not suggesting the Government is doing nothing about it, but it’s this urgency that we need to see much more evidence of.

What we’re seeing in Ruabon now is happening all too frequently in Betsi Cadwaladr. Previously, your Government has hinted that bringing GP services in-house isn’t a problem. You’re cool about that. This hasn’t been regarded as something that should be of huge concern. Some might see this as a sign that you’d be more than happy to get rid of the independent contractor model anyway. So, perhaps you’re not doing enough to help surgeries recruit until they can go in-house. I’ll leave you to comment on that. But, will you commission independent research examining what the impact on patients is when this happens? Because they are the most important ones in all this.

Thank you for the series of questions. I don’t accept your opening gambit that surgery after surgery are handing back the keys as if there is a widespread movement. More than 95 per cent of practices are still managing themselves. To suggest otherwise is to overplay it in a manner that does not get borne out by the facts. The overwhelming majority of primary care and GP services are delivered by the independent contractor model. For the future, the independent contractor model will continue to deliver the great majority of GP services. What we are saying, together with partners in general practice, and other parts of the healthcare world, is that we think there will be different models alongside the independent contractor model in the future. For example, in Brecon, we’ve seen a community interest company created by GP surgeries working together to help to deliver care in a different way. We see the federation model in Bridgend. We will probably see, as I said before, a smaller number of single-handed practices in the future, and more of a federation between different parts of general practice, but also with that wider primary care team. And it’s not for the Government to try and impose a single model across the whole primary care sector. It is for us to support them and work alongside them. Actually, the way that clusters are bringing people together has been really exciting and genuinely successful, and encourages people to share their problems, but also share answers too.

I think this is a time to recognise the challenges that exist, and this Government certainly does so. We’re having those conversations about what we could and should do, together with our partners right across primary care, to make sure that primary care has a fit and healthy future to continue serving the people of Wales—in a different way of working, yes, in the future, but to continue a high-quality healthcare service.

Thank you, Cabinet Secretary.