2. Will the Cabinet Secretary make any assurances to increase the proportion of the NHS budget spent on primary care in Wales? OAQ(5)0143(HWS)

We are already investing more in primary care in Wales. Overall, we spend some 22 per cent of our health budget on primary care services. I’m providing an additional £43 million a year through the national primary care fund and I recently announced that the new GP contract will increase investment by £27 million in the year just ahead of us.

I welcome those increases. To the extent that health systems in the UK have a reputation internationally for delivering good value, considerable emphasis is placed on the role of GPs as gatekeepers to the significantly more expensive parts of the system, particularly in hospitals. Given the pressures on GPs, would it not potentially assist the health Secretary, with the deficits he faces at hospitals and pressures elsewhere in the system, if he could ensure a steeper increase still in the investment going into GPs and their recruitment?

I wouldn’t quite agree with your reference to GPs as being gatekeepers. GPs are much more than gatekeepers to other parts of our healthcare system and service. What we are progressively doing with our partners in both the Royal College of General Practitioners and in the BMA is we’re looking to develop an agreed agenda on having a broader multidisciplinary team, of which GPs are essential leaders for primary care. I’m genuinely encouraged by the work being done in primary care clusters. And it’s fair to say—and I think I’ve said this before—that a range of GPs were relatively cynical about clusters when they were introduced, whether it would be an exercise in bureaucracy rather than service development and improvement, to help them deal with the very real pressures that they face. But there’s been a real buy-in into clusters, and GPs themselves can see how services are being developed and delivered with them in a leadership position to improve the quality of care they’re providing, but also to do something about the workforce pressures that they themselves face.

So, we’ll continue to deliver investment to support our aims and objectives of making sure primary care really is the continuing engine of the NHS here in Wales and we’ll continue to respect doctors and to have a genuine conversation with them and other healthcare professionals. I’ll have more to say in the rest of this year about recruitment and a range of other issues as well.

Cabinet Secretary, obviously earlier in the week it was well documented that four of the health boards are facing significant financial challenges, double what their equivalents over the other side of Offa’s Dyke are facing, and it will be a real struggle for many of these health boards to be able to reconfigure some of their services whilst managing those budgetary pressures. How confident are you that the four health boards—in particular, Hywel Dda has a budget deficit of nearly 10 per cent for this year—will be able to reconfigure services to the primary sector, given the pressures they face, on their budget, just managing what they’ve got?

I don’t accept your characterisation of the deficit as double what’s across our border. Over 90 per cent of trusts in England are in deficit. I just don’t accept that is an accurate and honest presentation of the position. In terms of the reality of managing within their means and managing to reconfigure services and deliver—a reshaped primary care—that actually relies on our relationship with our partners. It relies on our ability to recruit the right mix of staff into working in a different way. The direction of travel we are taking is actually encouraging people to work in Wales, and to stay in Wales as well. It’s a better environment for GPs to work in, as well as other professionals too.

There will never be a time when the NHS is free from financial pressures—and I don’t try to pretend that at all. But I don’t think that the conversations around the headline deficits that we’ve discussed at length over the last two days are any sort of excuse for not getting on with delivering a much greater emphasis on primary care, in shifting services into primary care, and recognising the key importance of this area of the service for the future of our national health service.

Can I raise a point of order, Presiding Officer?

No, you can’t.