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.