The following amendments have been selected: amendments 1, 3, 4, 5, 6 and 8 in the name of Rhun ap Iorwerth, amendment 2 in the name of Jane Hutt, and amendment 7 in the name of Paul Davies. If amendment 2 is agreed, amendments 3, 4, 5 and 6 will be deselected.

The next item on the agenda is the UKIP debate on general practice and I call on Caroline Jones to move the motion. Caroline Jones.

Motion NDM6214 Caroline Jones

To propose that the National Assembly for Wales:

1. Recognises that the majority of patients their first, and sometimes only, contact with the NHS is through general practice.

2. Regrets that, despite this, general practice receives less than eight per cent of the health budget.

3. Calls on the Welsh Government to prioritise general practice with significant investment in resources, people and infrastructure.

Motion moved.

Diolch, Lywydd. I wish to move the motion before you tabled in my name.

The first contact the most of us have with our national health service is through our GP. Thankfully, for the vast majority of us, this is the only contact with the NHS. There are just under 2,000 general practitioners in Wales working out of the 454 GP practices across Wales. While this sounds like a lot, it equates to just over half a GP for every 1,000 patients. We also have a third of the adult population of Wales who report having at least one chronic condition, combined with the fact that in the last decade GP numbers have remained largely static.

We know that the impact of chronic conditions will worsen over the next few decades as the number of people aged 65 and over will increase by about a third. Our GP population is also aging, we now have a quarter of our GPs aged 55 and over. This, combined with the fact that GP training posts are not being filled—

Would the Member take an intervention?

Yes, certainly, Janet.

Would you agree with me, isn’t is normally correct for a Cabinet Secretary or a Minister to be present in the debate to respond to you and to all the others of us who want to contribute to a UKIP debate?

That’s not a matter for Caroline Jones. You can carry on with your speech.

Thank you. This, combined with the fact that GP training posts are not being filled, the fact that many GPs are seeking early retirement, and the large number who are seeking to work part-time due to workload pressures, is a recipe for disaster.

General practice is facing increasing and unprecedented pressures. There is a significant and growing gap between the demand placed upon it and its capacity. These pressures are not limited to one area; general practice is being forced to try and cope with inadequate resources, an unsustainable workload, and a workforce under considerable strain across the whole of Wales—[Interruption.]

I can’t take another one Jeremy, I’m so sorry.

Those are not my words, they are comments from the BMA. Both the BMA and the Royal College of General Practitioners have, for the last three or four years, been warning of an impending crisis in general practice. They have both been calling for an increase in GP numbers, but their calls have sometimes been ignored. Yes, the Welsh Government is listening: they launched a new recruitment campaign for GPs in October, but it’s not enough. We need to be recruiting around 200 GPs a year. Instead, we are struggling to fill 125 training places available each year. The new recruitment campaign will help, but it is not enough.

The BMA and the Royal College of GPs have both asked for greater emphasis to be given to Welsh students studying medicine at Welsh universities, as those students are most likely to remain in Wales. Cardiff are asking for the equivalent of eight A* at GCSE for their courses. Many of the doctors working in the NHS today have readily admitted that they wouldn’t meet that criteria. We are not asking for a dumbing down of courses, just more realistic entry requirements, and a greater focus on Welsh domiciled students.

It’s not just the numbers of GPs we need to increase. We also need a Welsh Government that has a stronger focus on and commitment to general practice and primary care. The majority of the Welsh NHS budget does go to secondary care. Prior to 2004 spending on general practice was over 10 per cent of the total NHS budget. There were ambitious plans for expansion, for new services, competition for jobs, training places were oversubscribed and morale was high. Since then, funding has fallen to between 7 and 8 per cent, and general practice does not have sufficient funds for workforce, premises or services. Over the same period, consultation rates have skyrocketed and more burdens are being placed on general practice by secondary care.

A poll conducted by the Royal College of GPs found that 84 per cent of GPs worry that they may miss something serious because of an unreasonable workload, and 92 per cent of GPs worry that a lack of resources is putting patient care at risk. Over half of the GPs surveyed said they either planned to reduce their hours or leave general practice altogether within the next five years. Seventeen per cent of GPs have sought support for work-related stress in the last two years. I know of one GP who routinely has to see over 100 patients during a consultation session. This isn’t good for either patients or doctors.

We are seeing the impacts of this strain on general practice throughout the NHS. One of the reasons we are seeing ambulances queuing up outside our hospitals and people waiting more than 12 hours in accident and emergency is as a direct result of an overworked general practice. People who can’t get to see their GP turn up at hospital.

Both the Royal College of GPs and the BMA have called for funding for general practice to rise to over 12 per cent of the NHS budget. The Royal College of GPs say that increased spending on general practice could save the Welsh NHS over £90 million by 2020. The royal college figures are based on detailed research by Deloitte. The research shows that increasing spending on general practice across Wales by around £3.5 million each year to pay for things such as more GPs and practice nurses could reduce A&E visits by over a quarter and have savings of around £21.5 million each financial year, rising to annual savings of around £34 million by the end of this decade.

Both the BMA and the Royal College of GPs agree that we need to invest and improve the infrastructure available to general practice. We need to make greater use of technology to enhance patient care, speed up diagnostics and streamline services. GPs in Wales are still waiting for the introduction of electronic prescribing, something enjoyed by their colleagues across the border. Electronic prescribing enhances the patient experience, it is safer for patients and reduces the workload on GPs. The IT infrastructure available to the NHS in Wales is abysmal. It’s the twenty-first century and we are still relying on snail mail and fax machines. Improvements, when they do come, are slow in coming. We need to ensure that the infrastructure we have in place is fit for purpose, able to adapt to future need and actually reduces the workload of our GPs, rather than adding to the bureaucratic burden.

Colleagues, we are facing a crisis in general practice. A crisis if left unchecked will undermine our entire national health service. We cannot go on ignoring the problem or tinkering at the edges. We need significant investment in general practice, significant investment in people, significant investment in resources and significant investment in infrastructure. But we need that investment now.

I urge Members to show our hard-working, or should I say our overworked, GPs that we support them 100 per cent by backing the motion before you today. UKIP will not be supporting the amendments by the Welsh Government and we will be rejecting Plaid Cymru’s amendments. We will support the Welsh Conservative amendment because it adds to the debate and does not detract from the core message I would like to see go out from this Chamber today.

We value GPs and general practice. They are the cornerstone of our NHS, and the National Assembly for Wales will do all it can to ensure that GPs have the funding and support they need in order to treat patients in a safe and timely manner. Diolch yn fawr.

I have selected the eight amendments to the motion. If amendment 2 is agreed, amendments 3, 4, 5 and 6 will be deselected. I call on Rhun ap Iorwerth to move amendments 1, 3, 4, 5, 6 and 8, tabled in his name.

Amendment 1—Rhun ap Iorwerth

Delete point 1 and replace with:

Recognises that the majority of patients have chronic conditions that are best managed in the community, and this requires strong primary care with general practice at the centre.

Amendment 3—Rhun ap Iorwerth

Insert as new point after point 2 and renumber accordingly:

Notes that social care budgets have faced significant financial pressures, and regrets that social care’s role in contributing towards primary care health services has been neglected.

Amendment 4—Rhun ap Iorwerth

Insert as new point after point 2 and renumber accordingly:

Regrets that there has been a decline in the number of GPs in recent years; notes that a strong primary care service will require significantly more GPs working alongside other health professionals; believes that other health professionals should complement and add to the service provided by GPs, and should not be used to replace them.

Amendment 5—Rhun ap Iorwerth

Insert as new point after point 2 and renumber accordingly:

Notes that many GPs have chosen to come to work in Wales from outside the UK, and that they may choose to leave if the continuing hostility towards migrant workers continues.

Amendment 6—Rhun ap Iorwerth

Delete point 3 and replace with:

Calls on the Welsh Government to ensure primary care, secondary care, and social care work together to help patients manage their conditions in the community, with a focus on prevention of hospital admissions; and recognises that this will require proper long term workforce planning, investments in infrastructure, and wider government policies to promote good health.

Amendment 8—Rhun ap Iorwerth

Add as new point at end of motion:

Calls on the Welsh Government to publish regular performance data for primary care, with performance indicators and targets established in collaboration with health professionals.

Amendments 1, 3, 4, 5, 6 and 8 moved.

Diolch yn fawr iawn, Lywydd.

I move the amendments tabled in my name. It is a timely and appropriate debate, perhaps not for the reasons the party opposite think. It’s timely because, once again, the party’s new leader has confirmed that his party’s long-term goal is to privatise the NHS—[Interruption]. He has, once again, placed on record his view that he has not changed his mind that the very existence of the NHS stifles competition. So, this debate must be seen in that context. Unfortunately, senior UKIP figures keep on making gaffes when it comes to health. We know that Nigel Farage doesn’t think smoking has any links with cancer. Roger Helmer has called for the NHS to fund gay cure therapy. Last week, the health spokeswoman here spoke against the taxation of cigarettes on the grounds that we haven’t reduced the number of smokers by much. A quick check of those facts: 20 years ago, almost 30 per cent of 15-year-old girls and almost 25 per cent of boys were smokers. Now, teenage smoking is at an all-time low, with just 8 per cent of boys and 9 per cent of girls smoking. Adult smoking has reduced from around 30 per cent to 19 per cent over the same period, but what do the experts know, and what do the statistics show, eh?

Leaving aside those points, strangely enough, we support the sentiments of the motion, but we do think it needs considerable amendments to more accurately reflect the challenges and the sorts of solutions that we need within the NHS. Amendment 1 reflects the fact that, in the modern NHS, the majority of patients cared for are, in actual fact, repeat users of the service who require ongoing contact and care with primary health to manage their chronic conditions. This really isn’t about the one-time user whose first and only contact is with a GP.

Amendment 2 notes the importance of good social care in contributing towards these goals—something we’ve talked about here this afternoon already—noting the financial pressures that have been imposed on social care, probably as a result of a right-wing agenda not understanding the role of social care and believing that austerity is a consequence-free political choice.

Amendment 3: this one’s targeted at the Welsh Government. It notes that GPs will always remain at the centre of good primary service. We note the decline in numbers, although the Government likes to show a different set of figures at times. The facts are clear: we had 2,026 GPs in 2013, and 1,997 GPs in 2015, which are the latest available statistics. Other health professionals are a vitally important part of primary care, but they shouldn’t be used to replace GPs. They should, of course, be used to complement them. We note, from the Royal College of General Practitioners’ calculations, that we need perhaps 400 additional GPs in Wales. It’s a figure we certainly see no reason to doubt, and I draw your attention, of course, to Plaid Cymru’s long-standing position: that we need to move over a period of years towards the employment, training and recruitment of 1,000 extra doctors in Wales.

In amendment 4, we return to the contradiction in UKIP’s health policies, by noting that many GPs, surprisingly, are not in fact British, and that if the climate of hostility towards migrant workers that UKIP has helped to inflame continues, they may choose to leave the NHS. I do wonder whether they are serious about—[Interruption.] I’m sorry; would you like to intervene?

Yes, I would, actually.

Well, I’d very careful what you say.

I feel this is rich. You constantly make comments across the Chamber about Neil Hamilton not living here, and living in England, across the border, so I think that what you’re saying is quite rich, actually.

Are you able to provide any evidence of that?

Yes. We’re looking at it on past—

I’ll take another intervention, by all means, or we can return to the subject at hand.

[Continues.]—on past Plenaries. On past Plenaries. The evidence is there.

Rhun ap Iorwerth, there is no intervention. Carry on with your speech.

There is no intervention because the Member is, quite frankly, being ridiculous.

In amendment 5, we become more specific about how primary care needs to improve. It requires a combination of primary care, secondary care and social care working together far more, with investments made in the most appropriate place rather than setting arbitrary percentages, and working alongside wider Government policies that promote good health—for example, heavy taxation on cigarettes.

In amendment 6, we note that alongside these investments we really need to have—and this is something I know I’ve discussed with the Cabinet Secretary on a number of occasions, including in this Chamber—the regular publication of as many and as broad a range of performance data on primary care as possible. In order to map the way ahead for primary care, we need to have the tools at our disposal, and that certainly includes having the right and the best data at our disposal. Support our amendments today.

I call on the Cabinet Secretary for health to move formally amendment 2 in the name of Jane Hutt. Before he does so, I’m sure he will want to apologise to the Chamber and to the proposer of the motion today for arriving late for the debate.

Amendment 2—Jane Hutt

Delete all after point 1 and replace with:

Recognises the extent to which Welsh Government continues to invest in primary care services across Wales and the ongoing commitment to work in partnership with GPs and other primary care professionals to improve care for people across Wales.

Amendment 2 moved.

Indeed, Presiding Officer. I recognise it’s my responsibility to be here on time, and I do apologise to the proposer and to the Chamber for being late for the start of today’s debate. So, I apologise without hesitation, and I formally move amendment 2 in the name of Jane Hutt.

I now call on Angela Burns to propose amendment 7 in the name of Paul Davies. Angela Burns.

Amendment 7—Paul Davies

Add as new point at end of motion:

Recognises the importance that allied health care professionals play in ensuring that primary care is effectively delivered.

Amendment 7 moved.

Diolch, Lywydd. With some trepidation I’m going to try and pour some oil upon these troubled waters, because we support entirely your motion. No-one can dispute how incredibly important general practice is to sustaining and delivering national health services. We also support the amendments by Plaid Cymru, because you actually detail facts, although I do think that you are very naughty, Rhun ap Iorwerth, for trying to paint us with the sins of our fathers, or the sins of the big brother across the other side of the wall, because here, this party is very, very supportive of social care, and we have demonstrated that on many an occasion. I’d also like to say that, in reference to amendment 5, the Welsh Conservatives have absolutely zero tolerance for anybody who assaults, abuses or shows hostility to any member of the national health service, because it is a crime that is not acceptable on any level.

Primary care is vitally important to our national health service. I’m grateful to you for bringing this debate. I do feel that I’m unable to support the Government’s amendment until after the Cabinet Secretary has spoken, because I would like to see what he intends to do to support primary care, because I feel that there’s been a neglect of primary care services. We believe that it should be a leading priority for the Welsh Government, in an effort to improve the NHS. Overwhelmingly, general practices are the first instances in which patients will come into contact with the health service, and consequently are one of the most important aspects of the public’s interaction with the NHS. Despite this, we’ve seen the number of general practices in Wales decline by almost 9 per cent over the last 10 years.

Quality primary care is essential in reducing the burdens on our hospitals and emergency services. The more resources we can give our GPs to quickly diagnose and treat patients, the more space we can free up elsewhere in the health service. I think we’ve seen again and again under the Welsh Labour Government that waiting times for treatment and diagnosis in our NHS have lagged behind. I want to make it clear to the Welsh Government, not for the first time, that what is most needed, and yet most overlooked when seeking to rectify this anomaly, is extra investment in primary care.

In Wales, our GPs are inspiring in their ability to make the best of what they are given. However, they are too often underequipped and subsequently unable to handle the situation themselves, forcing them to refer their patients to a hospital or specialist. This is an extra pressure on the NHS, and we need to be giving GPs the ability to take as much pressure off the secondary care sector as possible.

I’d like to give a couple of examples of where I see this work. This is why we’ve brought forward our amendment about the incredibly important role of the allied healthcare professionals involved in multidisciplinary working in a GP practice. I want to just cite one example, of Argyle Street Surgery in Pembroke Dock, which is one of the largest, if not the largest, general practice surgery in the whole of Wales. Their multidisciplinary working team that they have put together, and have been enacting now for quite some time, has allowed people to be seen by the correct person at the correct time. These are their words, not mine: they say that the benefit it brings to them is that it allows continuity of care by the most appropriate person, and it doesn’t have to be a GP; that there’s been a reduction in admissions, improved patient care and, above all, improved patient satisfaction. They say it allows people to exercise their skills and talents, that it’s led to improved end-of-life care and reduced admissions for patients with cancer and non-cancer. It’s increased, above all, job satisfaction.

Their multidisciplinary team—I’ve been to see it, and it is quite extraordinary. They have pulled together a whole raft of people, and they work as this dedicated team that answers the patient’s need. Pembroke Dock has some incredibly deprived areas with people with complex issues and a lot of comorbidity, yet the happiness factor is slowly increasing there, because people understand that they’re seeing, in their own home, an occupational therapist; they’re being able to access a physiotherapist without having to go to the hospital; or they can see the same palliative care nurse who’s going to look after them throughout their entire end-of-life process, not just at the very end, but from the start of that diagnosis all the way through.

That’s why I think it is so vitally important that we not only recognise the importance of these allied healthcare professionals, but recognise that a good GP practice for the twenty-first century must encompass more than just a doctor, and the doctors will say this as well. I would like to see the Cabinet Secretary explain to us how he’s going to put forward enough funding and enough training into general practice in order to enable GPs to be able to develop along this way. I appreciate that the clusters are really beginning to work well in some areas, but there’s still inconsistency in continuity of practice throughout Wales, and we need to ensure that a place like Argyle Street Surgery can actually become a template for general practice throughout Wales. Thank you.

I’m always entertained by UKIP debates, because they do paint a picture of a country from a bygone era. I look at the motion that they’ve tabled today and we hear mention only of GPs—we fetishise the family doctor. There is a consistent theme that UKIP paint a picture of the 1950s, and today’s motion is no different to that. It reminded me of some of their most recent policies—the most quirky policies that they’ve come up with, entirely in keeping with this bucolic picture they paint of the British countryside—

Will the Member take an intervention?

Let me just develop my point a little. Policies they suggested just six years ago of proper dress in the theatre, repainting the trains in traditional colours, more swearing allegiance to the Queen, cheaper beer and bringing back imperial measures. This is the 1950s, where, of course, the family doctor was the lynchpin of the primary care model. Reading UKIP’s motion today, you’d be forgiven for thinking that they want to recreate this approach to primary healthcare today.

But, of course, times have changed. Demand has increased—as Caroline Jones noted in her own opening remarks, the pressure on GPs now is considerable. GPs are seeing more than 50,000 patients a day. This has a knock-on effect on the whole health system. I was in Prince Philip Hospital in Llanelli recently, and they explained to me that the average age of a patient there now is 82 years of age. So, the whole system is under immense demand, and, of course, it has to change to meet those demands.

One of the challenges that modern healthcare faces is being able to develop a new system while also running the old system in parallel. So, there will be strains and struggles from time to time, but the new model is gradually emerging. The advantage of the new model is that it respects and elevates the skill and training of a GP, and frees them up to look at the more complex cases, while some of the other things that traditionally a GP might have done, or indeed services that simply weren’t in existence back in the 1950s, are done by a range of allied health professionals.

So, for example, we have now in many modern primary healthcare settings paramedic practitioners, prescribing pharmacists, physiotherapists and occupational therapists, all offering tailored support to people at the time that they need it, when often the GP is not able to do so. For example, I mentioned earlier that I welcomed the Cabinet Secretary to the Kidwelly surgery of Minafon recently, where we saw a prescribing pharmacist working part-time in the surgery, who’s been able to do a review of all patients with asthma in the practice, to review their medication and to provide them with advice, which is something a GP-led model only would not have been able to do— they just simply wouldn’t have had the time. And also, we need to pay heed to the principles of prudent healthcare—that you only do what only you can do. And I think that this new model plays perfectly into that philosophy.

Of course, there are challenges in being able to replicate this model. As we heard the health Secretary say earlier, there are only 15 managed practices currently in Wales, and obviously when you are managed by the health board, you have greater freedom and flexibility to be able to innovate, and to be able to start from scratch and reassemble a model fit for purpose. The system is going under organic change. I have spoken to GPs in Llanelli recently, who are having recruitment problems—they’re having doctors going off on maternity leave, they’re having huge problems recruiting, and locums, for example, are now demanding £1,500 a day in some cases in order to meet the needs of a practice, and they’re telling the practice what they will do, what hours they will work, what things they will do for that money, and holding them to ransom. So, there are huge strains that GP services have, and the GMS contract model is under huge strain and does need to change. And that’s why I think the UKIP motion is misguided, because it is basing its premise on a model that is slowly crumbling away.

We’ve heard mention from Angela Burns about the cluster model, which she said is patchy, and I think that one of the challenges the cluster model has is to try and encourage those GPs operating within the current contractor model—and something that people from outside the NHS often forget is that this is, in a sense, a private business still for many—these GP clusters need to encourage these practices to come together, to merge, and only in some parts of Wales is there support available for those GP services to do it—support for IT contracts, for finance, and so on. I think Aneurin Bevan and the ABMU currently provide a service to do that. And many GP practices, because of the sheer volume, simply don’t have the space to be more strategic. And that’s back to the point I was making earlier—we have the challenge of developing a new model of health care, while also running the existing model of health care, which is under huge strain.

So, I think it is time that UKIP left the 1950s, joined us in the modern world, and accepted that the GPs—[Interruption.] Sadly, David, I’m out of time.

Will you take an intervention please?

I’m out of time, I’m very sorry.

Won’t you take an intervention?

There’s an echo here. I’m out of time, sorry.

And accept that the new model can’t simply rely on GPs, as in days of yore. Thank you.

Thank you to the Member for bringing this motion here today, and you did so in a very eloquent and balanced manner. I welcome this debate, which highlights the absolute importance of the role of our GPs, and I have no fetish—as the Member suggested that my colleagues have in UKIP—about GPs, but they are a fundamental first step in any patient seeking a diagnosis. Primary care is indeed the first point of contact with the NHS for more than 90 per cent of our patients, yet surgeries in my constituency and across Wales are facing severe pressure, with patients contacting me regarding access on a daily basis. Llys Meddyg Surgery in Conwy ended its NHS contract last year as a result of an unmanageable workload, with both GPs working 12 hour days. Penrhyn Bay and Deganwy surgeries, seeing their GP provision drop from five to two. How do you mange those numbers of patients—thousands of them?

GPs are telling me now that the system is at breaking point. We’ve seen years of chronic underinvestment—yes, Members—and 17 years of a Welsh Labour Government, propped up by Plaid Cymru and the Lib Dems, have actually been responsible for the funding for our GP services across Wales. We’ve seen the funding fall by £20 million over four years and the sector facing severe staff shortage and surgery closures, leading to the Royal College of General Practitioners warning that GPs in Wales are facing a perfect storm of increased demand, burgeoning workloads and a shrinking workforce. The BMA highlighted its findings in the autumn, that more than a quarter of GPs in Wales are now considering leaving the profession. Sixty per cent feel they do not have a good work-life balance, and 80 per cent are worried about the sustainability of their own provision. The BMA have also described it as a crisis in GP provision.

Clearly, the system is under immense pressure. In 2005-06, GP care received over 10 per cent of NHS spend; now, it is down to less than 8 per cent. Where investment is made, it is not having the desired effect. The royal college of GPs has said of the recent £42.6 million invested into primary care that,

‘any money that’s coming through the cluster system seems to be really very slow in actually making any difference to most of the practices. The way that the clusters work is very varied across Wales, so that is putting increased inequalities into the system.’

Cabinet Secretary, how are you monitoring this? In the fourth Assembly, the Health and Social Care Committee, of which I was a member, called on the Welsh Government to address the GP recruitment and retention crisis. Scotland has a significantly higher number of GPs per head than Wales, with 8.1 per 10,000, compared to just 6.5 in Wales. The latest figures show the number of GP practitioners in Wales fell from September 2014 by nine just to 1,997. Furthermore, the proportion and number of GPs aged 55 and over now cover 23 per cent of the workforce. So, it is vital that the Welsh Government is proactive in ensuring the workforce is futureproofed ahead of the deserved retirement of many of our hardworking GPs.

Finally, our amendment, as touched on by my colleague, Angela Burns, seeks to recognise the importance that allied healthcare professionals such as pharmacists, nurses, physiotherapists, occupational therapists and paramedics play in ensuring that primary care is effectively delivered. Effective integration and joint working between the health and social care sectors is vital in relieving pressures on GPs. In conclusion, the immense pressure that the sector is under means that it is vital that the Welsh Government ensures significant investment in resources, people and infrastructure. My questions, to finish off, are: will you provide an update on the outcomes today of the implementation of your primary care workforce plan and the impact of the introduction of the clinical lead for primary care? What uptake has the refreshed employment offer and incentives for GPs coming to work in Wales had? We want to know. And finally, how are you working with medical schools in Wales to increase exposure to general practice during medical training? Cabinet Secretary, the crisis in GP provision is real; denial is not an option.

I call on the Cabinet Secretary for Health, Well-being and Sport, Vaughan Gething.

Thank you, Presiding Officer. I do welcome today’s debate, which highlights the importance of high-quality primary care services, and the opportunity to respond to some of the comments that have been made, but I’ll start by saying the Welsh Government continues to invest in primary care services across Wales, and this is in direct contrast to England. We will continue to work in partnership with our GPs and other primary healthcare professionals to improve care for people right across Wales.

We know the demand for GP and wider primary care services continues to increase, with about 19 million patient contacts a year. They continue to represent the great majority of NHS patient contact and act as a gateway to a range of other services. And I do recognise that winter places particular pressures on every part of our health and care system. Our whole system has only coped because of the extraordinary commitment of health and care staff. And I will note that that commitment by GPs has been poorly rewarded across our border in England, with a quite shameful attempt by the Prime Minister to blame GPs for winter pressures in accident and emergency departments. So, I want to state with absolute clarity: that is not and will not be my approach here in Wales. More than not blaming GPs, I took the decision to act in partnership with the BMA when I relaxed the quality and outcomes framework to the end of March, and that should relieve pressure on GPs and provide more time for patients. It is a clear example of this Government listening and acting, and that is the direct feedback I have had from GPs themselves.

Now, GPs themselves also increasingly recognise that they need and want to be part of that wider primary care team. That will mean the role of the GP changing, where they will be providing services for the more complex patients and co-ordinating the wider primary care team. Our national primary care plan sets out key actions to provide a more integrated and multiprofessional service in each and every community. And increasingly, those teams are being created around our 64 clusters. The team will include GPs, pharmacists, nurses, therapists, dental teams, optometrists, mental health teams, social workers, the third sector and others working together to provide the right care at the right time and in the right place.

And far from being a threat to general practice, as some feared, this new approach has significant buy-in now from our GP community. I’ve met a number of GPs who were, in honesty, broadly sceptical about the approach of clusters and a wider team, but they’re now convinced it is the right approach and they would not go back to the way of doing things in the past. And the use of money directly has been an important part of that. I just don’t recognise Janet Finch-Saunders’s comments that this hasn’t made any real difference. I met GPs today, as I have done on every GP visit, who can point to the direct contact and the direct use of that money and the difference it is making for their cluster, because they know their populations and are using that money accordingly.

The £43 million that we’ve invested in primary care over this last year has helped to provide more than 250 additional posts—GPs, nurses, pharmacists, physios, paramedics, occupational therapists and others. There are a number of really good examples of advanced nurse practitioners making a really big difference. A good example I saw was in Carl Sargeant’s constituency, in Hope, where that’s really helping to cope with some of the difficulties they’ve had around recruiting another GP, and they recognise that that’s been a really important addition to their staff team. I’ve seen more pharmacists employed directly by clusters to support GPs, to take work away from them and to provide better quality of care to those individual constituents, but it can be for the GP to have more time with patients they really need to see. Of course, Choose Pharmacy—we’ve talked about it previously—is the platform that does mean that more support can and will be provided in community pharmacies across the country.

I’m really pleased that many Members have recognised, both today in this debate and in earlier questions, the role of allied health professionals, and I welcome Angela Burns’s recognition of the Argyle Street pilot with occupational health, and we spoke earlier about Kidwelly and a number of different therapists there as well. But, in particular, physiotherapy has a big role to play in the future. Up to 30 per cent of a GP’s caseload will be musculoskeletal health issues, but about 85 per cent of those can be dealt with effectively by a physiotherapist without needing to see a GP. A pilot in north-west Wales has placed a physiotherapist in four GP practices, saving nearly 700 GP appointments over three months. As a result, that’s now been expanded to more than 40 GPs across north Wales. So, again, learning from what is working and doing things differently, rather than thinking about models simply from the past.

We’ll do this by working in collaboration with GPs in Wales, and in particular to address the challenges of GP recruitment, as we are doing currently. These challenges are not unique to Wales. What is unique is the approach in sitting around a table talking, discussing and agreeing on what we should do. So, we have the national and international campaign launched in October 2016, making clear that Wales is an attractive place for doctors, including GPs, to train, work and live, and I’ll have more to say on that in the coming months and about the results of that campaign. As part of that, we did, though, announce an incentive scheme. So, trainees who take up a training place in a specific hard-to-recruit area will be eligible for a payment of up to £20,000, and, from August this year, that scheme will begin in Betsi Cadwaladr and Hywel Dda university health boards. A second incentive of a one-off payment of £2,000 for exam costs to all GP speciality training programme trainees to help cover final exams following study in Wales is also being introduced. Again, feedback thus far has been very positive about those two measures. We will, of course, continue to look at where medical training takes place, the numbers of medical trainees and, in particular, of course, opportunities for Welsh domiciled students within that.

I want to be really clear that we have not cut funding to primary care. I’ve been disturbed by some of the alternative facts today that suggest we’ve taken money out of primary care. We have not done that at all. In fact, our overall financial investment across primary care has never been higher. In 2015-16, it was £878.5 million. That represented 13.7 per cent of the total health and social care spend. In percentage terms, that is more than Scotland spends on primary care on the same basis, in terms of defining primary care, as the Royal College of General Practitioners agreed in Scotland. The challenge always is how we divide up a finite budget to meet our competing priorities across both primary and secondary and the whole integrated system.

We announced additional capital funding in the final budget of £40 million to re-engineer the health estate here in Wales and to deliver more integration between health and social care that will be targeted at that new generation of centres to make sure we deliver more care closer to home. But we know GPs and the wider primary care team face a very real challenge, and not just in winter. That is why primary care remains a priority for me. That is why I called a national event in October to bring together health boards to look at what they have done to deal with their challenges, to understand what the challenges are currently, what they’re doing about them, what the buy-in is from the GP communities and beyond. And it was a successful day, because I could see the way that GPs are having more of a buy-in and more of a leadership role in determining, with their health board partners, what they will do and who they will do it with.

I’m really excited about the opportunity for more learning right across our whole system and that will only happen with a continued focus and continued emphasis on partnership. That is what I’m really encouraged about with our clusters—that partnership ethos that is developing, the leadership of GPs of their local primary healthcare team. That is an essential part of our future success for primary care here in Wales. I look forward to continuing to work with our GPs and our wider primary care team to deliver the high-quality primary care services that all of us would wish to see.

I call on Neil Hamilton to reply to the debate.

Diolch, Lywydd. I’m pleased to respond to this debate and I welcome the contributions made by Angela Burns and Janet Finch-Saunders in particular, which added to the points that Caroline Jones made in her opening statement. I do deprecate the manner in which the Plaid Cymru spokesman began his speech today, which certainly subtracted from the sum total of human knowledge by misrepresenting the position of my own party on the national health service.

Would you give way?

Not yet, but I will give way later. Because UKIP in its manifesto in May in Wales, and in the general election in England last time, stood firmly on the principle of a national health service funded from taxation and free to the user at the point of delivery. It was a calumny and I’m afraid he demeaned the quality of debate and demeaned himself by the way in which he opened his speech. I’m disappointed, frankly. I am disappointed with him because we have a great deal of sympathy with the points that are made in the Plaid Cymru amendments, apart from amendment No. 5. No country in the world wants totally unrestricted immigration. We don’t have unrestricted immigration from the rest of the world outside the EU, but the tone of amendment 5 is that Plaid Cymru is actually opposed to all forms of immigration control because they regard that as a kind of racism and designed to increase hostility towards migrants. The reason why there is any hostility towards migrants today is very largely because of the failure of Governments to control immigration. [Interruption.] Plaid Cymru are evidently in denial—86 per cent of the country, according to the Government’s White Paper, which bears the name of the leader of Plaid Cymru, want immigration to be reduced; Plaid Cymru does not and I’m very happy to go into an election campaign on that basis.

Member of the Senedd:

As are we.

And no doubt you’ll do as well as you have in the past.

Will you take an intervention? Will you take an intervention?

It’s too late now. I haven’t time and frankly I don’t think it would be worth it. [Interruption.] But I want to refer also to—[Interruption.] I don’t think I’ll have time to reply to the debate.

It’s up to the Member whether he wants to take an intervention or not. Carry on, Neil Hamilton.

I regret also that my friend, Lee Waters, spoiled what was otherwise a very good speech, with which I largely agreed, by making some caricature points about UKIP wanting to go back to the 1950s. It’s not even worth responding to that. I just wish that Members in this place would live up to the qualities of respect that they keep urging upon us but, so often, they don’t live up to themselves. I’ll give way to Mark Isherwood.

Will you recognise—[Inaudible.]—you only have to go back five years when both BMA Cymru and the Royal College of General Practitioners aimed campaigns at Assembly Members warning them that we would get here, that 90 per cent of patient contacts are with general practice and yet funding as the share of the NHS cake had fallen, and they’ve had to relaunch those campaigns now because they didn’t listen.

And so the point that I would make to Lee Waters is the fact that our motion didn’t mention many other good things, such as those which he adverted to in his speech, doesn’t mean that we want to take the NHS back to the 1950s or that we see the problems with reducing the proportion of the NHS spend on GPs as being the sole cause of its difficulties. I’m afraid that Plaid Cymru is not part of the solution; they’re part of the problem, because they supported Welsh Labour’s cuts over the years to the proportion of the NHS budget that is spent on GPs, and they support, and continue to support, budgets and policies that have increased the burdens on general practice. So, we know very well that, actually, they are part of the disease, rather than being the doctors that cure it.

Caroline Jones referred in her speech, as did Angela Burns and Janet Finch-Saunders, to the realities of general practice. We have a static number of GPs in Wales, we have an ageing workforce amongst GPs and we have an ageing population, so that there is a pincer movement now between the limitations in the supply of medical services on the one hand and increased demand.

Recruitment is a great difficulty. I accept that the Government is doing a great deal to solve the recruitment crisis, but, nevertheless, fundamentally, it is about rebalancing the NHS budget and putting more money into general practice, otherwise we’ll get ourselves into the same situation that we have in England, where hospitals are overwhelmed in A&E departments because of an inadequate provision of money for GP services.

One of the interesting facts that has not been mentioned today about the NHS in Wales is that the number of GP retainers has fallen so substantially in recent years—people who work only for a few hours in the week. That is a means of increasing flexibility within the system and enabling these pressures to be dealt with. That’s something that I hope that the Government will address in the years ahead.

The Government should tell us how it intends to meet the target that itself set of a six-hour maximum wait for housebound patients who can’t get to the surgery. I know of many cases, anecdotally, where people are waiting up to 20 hours for a home visit, and that is completely unacceptable in the modern world. So, it’s not back to the 1950s. Here we are in the twenty-first century, but we have to recognise that there is a limit, obviously, to the amount of money that can be spent on the health service. There is a limit to the amount of money that is available, but, nevertheless, I think, within the total, there needs to be a complete rebalancing to go back towards where we were five years ago, when a much greater proportion was spent on GPs, and I commend our motion to the Assembly this afternoon.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Therefore, I defer voting under this item until voting time.

Voting deferred until voting time.