6. Will the First Minister outline the Welsh Government's plans to improve access to primary healthcare? OAQ(5)0574(FM)

Yes. Through modernising our primary care services, we want access to continue to improve. When local issues arise, as they will, we expect health boards to ensure local needs continue to be met.

In my constituency, we’ve experienced big problems with GP retention and recruitment, and it’s of particular concern in the Rhondda because we have an ageing population and an ageing GP population to match. Last year, we saw the closure of Tŷ Horeb surgery in Treorchy, and, less than a fortnight ago, Maerdy surgery patients were told to go to Ferndale surgery because GP cover could not be arranged for that particular day. This caused a lot of concern in an area where appointments are difficult to come by at the best of times. With all the problems in the NHS in England, why is recruitment such a problem in Wales? Doctors should be falling over themselves to come and work in Wales, but you’ve failed to capitalise on that situation. Do you also regret that, after 18 years of Labour running the NHS in Wales, we still have one of the worst patient-to-doctor numbers in the whole of the EU?

We have more GPs than ever before, and we are at the stage where more and more GPs are looking to come to work in Wales. It’s hugely important that the structure of general practice in Wales is attractive. It is a reality, to my mind, that more and more GPs want to be salaried. They don’t want to buy into a practice. They don’t want to work within that model. Why? They’ve come through medical school with debt—to actually fork out more money is not an attractive proposition for many of them. The contractor model will be attractive for some, and that’ll be an important part of the NHS for years to come.

She is right about what happened in Maerdy. I know that there was an issue there on one day; because of an unforeseen circumstance, the cover wasn’t there. That is something that I can understand people in Maerdy being frustrated about. It’s part of the Ferndale practice, but, nevertheless, there is a branch surgery in Maerdy. What we are finding, of course, is that, for example, we’ve seen a 16 per cent increase in the number of GP training places filled so far compared with last year. The £43 million primary care fund has helped provide more than 250 additional primary care posts, including GP and nursing posts, pharmacists and physiotherapists. Importantly, work is being taken forward in Cwm Taf—of course, the Rhondda’s part of that—working across eight practices in one cluster. So, surgeries that are quite small and that do find it difficult to provide cover at the level that will be expected these days are able to work together in order to provide the comprehensive cover that people need.

Patients not only need to have access to good GP surgeries and good GPs, but also they need to have quality in that access. We all accept, and I think there’s a growing recognition, that GPs should be left to deal with the more complex cases and those with multiple comorbidities. We welcome the growth in the allied healthcare professionals, and we welcome the growth in having counsellors in GP surgeries, and in having chronic care condition nurses, palliative care specialists and so on. But I do wonder, First Minister, what discussions your Government might have had in terms of extending the appointment time. Because if a GP who is already under enormous pressure has to see a patient with complex healthcare issues or comorbidities and write up those notes, the standard 10 minutes is a very difficult thing for them to undertake all that work in. I wonder if your Government has had any consideration of that particular matter.

Can I welcome, first of all, what the Member said about not piling—that’s not the way she put it, but it’s what she meant—all the pressure on GPs? A good number of cases that appear before GPs don’t need a GP, which is why it is hugely important we have Choose Well, of course. We see, when health boards take over practices, that they become multidisciplinary. People can be directed to the nurse, to the pharmacist, to the occupational therapist or to the physiotherapist, as appropriate, rather than everybody piling on to the GP. The challenge for the smaller practices is to be able to take pressure off themselves in the future, by working with other practices to provide wider and more holistic services between them. So, for example, is it reasonable for a single-handed practice to employ lots of nurses or physiotherapists? No, but working with other practices, it then becomes far more viable for that to happen. But it is hugely important that we don’t—she doesn’t do this, in fairness—it is hugely important for us not to think that primary care is just about GPs; it’s about making sure that people get the right level of care the right time. You take away the pressure on GPs, you release more time for them to see the patients who need more time to be seen.