6. Will the Cabinet Secretary make a statement on the current provision of general practices in Wales? OAQ(5)0202(HWS)

Thank you. We are committed to high-quality general practice as a core part of a modern primary care service. Investment in general medical services will increase by £27 million in this financial year. This, together with £40 million for primary care estates and our £43 million primary care fund, supports the ongoing provision of sustainable and high-quality general practice.

I’m grateful for that reply, but the Cabinet Secretary will know that the national survey for Wales found that 39 per cent of respondents find it difficult to make a convenient appointment to see a GP, and 62 per cent overall were not satisfied with the service provided by the NHS in Wales. Since 2004, as a proportion of NHS funding, general practice has declined from 10 per cent of the total to 8 per cent—admittedly, that’s gone up recently—but the British Medical Association say that in order to get to a satisfactory position, this should be 12 per cent of what we currently spend on the NHS. Can the Cabinet Secretary give us an idea of what response he would make to the BMA about that figure?

To be fair, this is the general practice committee of the BMA. I’m robustly confident that clinicians in secondary care would not wish to see a significant resource transfer between secondary and primary care. That is an honest part of our challenge: as we increase the money going into the health service—as I said earlier, at a painful and significant cost to other parts of public spending activity here in Wales—when you think about how and where we’ll invest that money, the honest truth is that delivering services in secondary care is more expensive than delivering services in primary care. So, even as we invest in trying to deliver more care closer to home—the example that Angela Burns gave earlier—that doesn’t always have the same cost attached, for example, as the significant capital you need to invest in a new generation of radiologists. So, there are honest choices to make here. What I’m determined to do is, as services move and are reconfigured, that funding is provided to make sure that that service is properly and adequately resourced. I don’t think it’s helpful to try and stick to a percentage figure within the NHS budget as the aim and the objective. The aim and the objective must be to deliver the right care at the right time in the right place, and with the right resources to allow people to do so.

Cabinet Secretary, when it comes to mental health services, there is evidence that good counselling services can prevent repeat GP attendances, and they have a proven track record of helping and managing and even alleviating mild to moderate symptoms. I do think this sort of innovation is something we need to see more of in the NHS, particularly if we want to retain more GPs, perhaps some of the older ones who are thinking about retirement, of which there are quite a large number in Wales. This is just an example of how we can help balance the workload and use GPs at their best for the actual sharp end of the service that’s required.

I agree that we need to consider how we make best use of professionals within the service, and outside the service as well. It’s a significant part of a GP’s caseload, actually, those sort of moderate to lower level mental health challenges that bring people through their doors. And it’s part of the reason why lots of primary care clusters are investing in counselling services with the resources that we’ve made available to them. Mental health and therapy services are some of the more significant and consistent areas, together with pharmacy, for that cluster investment. And it is about that general sense of well-being and how we actually address that as well. Sometimes, that is not a medical intervention. So, for example, when we think about social prescribing, much of that is actually about improving mental health and well-being as an alternative to, if you like, a formal talking therapy or, indeed, medication. That’s also why this Government has recommitted in our programme for government to undertaking a significant social prescribing pilot that we think will provide us with significant information on how to develop a service for the future that should make a real difference to mental health and well-being. And, obviously, we’ll look again, in a year or so, at the practice of Valleys Steps, which we think has made a real difference in this area already.

The Dolwenith surgery in Penygroes is closing at the end of the month and nobody will replace the GP who’s retiring. He was the only one providing Welsh-medium services in an area of 5,000 people where three quarters are Welsh speakers. The valley will have fewer doctors per head than the Welsh average and yesterday, in a very poor statement, you said that you wouldn’t be establishing a medical school in Bangor. How many other surgeries have to close? How many other locums will you have to pay a great deal for before you realise that a medical school is the only sustainable way of resolving the health crisis that faces us in north Wales?

Well, I don’t share the points that you make, and I think we could either have a conversation where we’ll continue to talk about how we deliver more medical education and training, and more healthcare professionals in every part of the country that needs them—north Wales, mid and west Wales and south Wales, too—or we could go through a rather formulaic, ‘You are responsible, it’s all your fault and I’m disappointed’. I don’t think that gets us very far. I’m happy to have a row if there’s a need to have a row, but I don’t think this is the area to do that. I actually think that the decision that we made yesterday was based on a proper evidence base about the right thing to do. I am concerned about our ability to recruit, retain, and attract people to work within the health service in Wales. That’s why the incentives, for example, on GP training in north-west and north-east Wales—we’ve filled those areas that were hard to recruit to previously. So, I do take seriously the whole model of care that we provide, but I don’t share the tone or the content of the remarks you make. I’m committed to delivering a proper health—[Interruption.]—a proper health service for communities right across Wales, including north Wales, and I resent the implication and accusation that I do not care about one part of Wales.

Thank you, Cabinet Secretary.