Thank you, Deputy Presiding Officer, and thank you to Huw Davies for another opportunity to speak today in the Chamber, but in particular for using today’s short debate to highlight the importance of accessing high- quality primary care services.

Our local healthcare services account for more than 90 per cent of people’s contact with the healthcare system here in Wales. Of all the points that were made today, it’s been really interesting that so much of it has focused on the hospital-based part of that system and yet the great majority—as I said, over 90 per cent—of people’s interaction takes place in our local healthcare service. And I certainly want our local healthcare service in Wales not just to be based on the principles of prudent healthcare as a mainstay of a sustainable health and care system that is generally able to respond to the changing needs of our population, but I share what you say as well: I want every single community across our country to have not just high-quality healthcare locally, but actually to have good access to it, to have really great care and to understand what that looks like. And in many parts of the country, that will look different to the system that has served us well up to this point in time, because I recognise the stress and the pressures that we frequently discuss in this place over the future of our local healthcare service, and in particular GPs as significant, if you like, leading parts of our local healthcare system, because we recognise that local healthcare is changing, and it needs to.

There are so many drivers that we frequently rehearse in this Chamber and otherwise, but we want it to deliver more care closer to home, with a more preventative approach: so, the idea of treating illness, moving beyond that to actually how you prevent ill health, and having a much wider team of people. That’s why our national primary care plan sets out key actions to improve local health, and that includes developing a more integrated, multi-professional workforce that collaborates at a very local level to meet people’s needs at, or close to, home, and recognises that much more care could and should take place in people’s own homes. I’m really pleased that you mentioned in your own contribution the reality that we want to keep people out of hospital. There’s much more that we could and should do.

I think that, sometimes, this sounds like a bit of a platitude, saying, ‘This is the course we want to do’, and then we go back, as politicians, to talking about hospitals again. If we can’t get this right, as we discussed in the parliamentary review, there’s a really difficult future ahead for the whole service. And, increasingly, though, we are seeing health boards collaborating with GP practices and other local service providers. Some of this is already happening, with pharmacists, community-based nurses, therapists, dentists, optometrists, mental health teams, social workers, third sector workers and others, through the 64 primary care clusters we’ve created. That’s to optimise the best use of our available resources and people’s time and expertise and the money we’ve directly provided to each of those clusters to spend on local priorities. Because I recognise that there are significant parts of Wales where they’re struggling to recruit and retain GPs. We talked about that earlier, in the Health and Social Care Committee’s report—not just the measures we’re taking on—[Inaudible.]—and others, but cluster working is a really important part of what we want to do to keep great local healthcare. That should lead, and is already leading, to greater collaboration between GP practices—they didn’t always talk to each other, frankly; so, it’s between the practices, not just within them—as they identify new ways of organising themselves and making effective use of their available resources.

Our national programme of Pacesetters has been really interesting in helping to identify more sustainable ways of working and providing services, like the federation of GP practices that is moving to the same place in the Bridgend locality, and the social enterprise in southern Powys, the Red Kite social enterprise. And that’s been so interesting, because that’s drawn together GP practices that previously did not talk to each other, and they were not friends of each other, and, now, they wouldn’t have it any other way. They’ve got a different way of working with each other, the way that people actually access the service, and they’ve just taken on board a GP service in Presteigne—where the previous GP practice was handing back its contract, they’ve taken that on. So, there is an appetite amongst the profession to work differently, because more practices are seeing the advantages of coming together to provide a better environment to work in for staff in the service, but also a better platform to deliver great local healthcare with and for the public.

I think this is where it comes back to how the national programmes can look at the challenges that you raise, because a significant part of the concern that is being taken up at the national Pacesetter programme is access. It’s a common concern about the ability either to get an appointment or to get a convenient and local appointment. Much of what you say is about access to local care. From that model, that new way of working with Pacesetters, much of it focuses on how you have a triage system, whether it’s on the phone or online or whether it’s nurse or GP-led, but a way to actually try and direct people to the right part of care. That could be going to see a GP; that could be having advice you can deal with at home; it could be going to the pharmacy; it could be coming in to see a physiotherapist or a different healthcare professional. And what we’ve seen in significant parts of that is that it actually speeds up access to see a healthcare professional, and it actually helps people to get directed to the right part of the service, so GPs don’t get overloaded with people they don’t need to see and, potentially, they don’t get to see people that they really could and should see, and I know this is an issue that the Member opposite has recognised in his own working practice well, about how you make the very best use of GP time. Now, more anticipatory care, to be designed to keep people at home rather than being admitted to hospital, and that’s where we’ve seen the development of the virtual ward-type models around the country as well—.

Now, the other part I just wanted to focus on before I go from the national to the local is the common element service in the way of pharmacy, because, again, you mentioned the point about could pharmacy be an option for people to get a service more locally. Actually, Cwm Taf have been really go-ahead on this in the way they’ve gone out after the Choose Pharmacy service. So, we currently have over 350 pharmacies in the country offering the service; 75 of them are in Cwm Taf. One of the pilots was in the Cwm Taf area, in Aberdare, and it was really interesting how the local GP practice recognised that it had helped them to manage the numbers of people coming through the door, and not just the numbers, but the appropriateness of people coming through the door as well. And people actually trusted their pharmacist. They had a private room to go and see them, they’re registered healthcare professionals, and it’s been enabled and empowered by access to a version of the GP records. There’s something about the safety. And, interestingly, Cwm Taf have told me that they think that the Choose Pharmacy service has helped to eliminate handwriting mistakes in scripts to be delivered as well, so there’s actually a significant benefit from a safety point of view as well. Now, in March, that service will be available to at least 400—certainly more than half—of the pharmacies in Wales, and we want to see genuine national coverage of this service.

It’s National Eye Care Week, but I won’t go on to talk about optometry because I do want to address directly the points you made about the local issue. And this comes on the back of an issue that other parts of the country recognise: population growth—current and planned population growth—that we know is going to happen, and you referred to Llanharan and Brynna being areas that are well connected from a transport point of view. The challenge is how we design so that services reflect what we currently have and will have, as opposed to waiting for those services to be overloaded.

And there’s something about the future of those services as well, and recognising that we want to work with independent contractors. So, we’d like to work with the current independent contractors to provide really good, high-quality care. And I do recognise what you say about the fact that this practice has invested in Pencoed. So, they haven’t been afraid to invest, and invested in one of those sites. And I also reflect on and recognise the comments that the CHC made on the potential that, if they can’t get somewhere where they think local residents want them to be, they may want to ask Cwm Taf to see if one of their other providers would want to come and open a list in the Llanharan and Brynna area. I think that means there’s a greater imperative to want to have a local conversation where—[Inaudible.]—there’s a different alternative.

That’s where I go back to the point to address the concern or the question that you raised about the offer of investment, and it partly deals with Suzy Davies’s concern about ABM as well, because my understanding is that the Abertawe Bro Morgannwg University Local Health Board did offer some investment for services to stay in the Llanharan and Brynna area. I don’t know why that hasn’t been taken up, but I am happy to ask if that previous offer from the Abertawe Bro Morgannwg health board area can still be on the table as part of an open conversation.

The final point, which I guess is your main ask from me, is whether I am prepared to use my good offices, to use one of those phrases, to try and engineer a conversation with relevant stakeholders. And I think it’s really important that you mentioned the local authority, because, to be fair to Rhondda Cynon Taf local authority, in other parts of their footprint they’ve been really helpful about making use of not just their ability to access capital in a different way, but also look at the estate that they have as well, to see if there’s an opportunity to try and re-engineer primary care with them as a partner—not just deliver what we currently have, but come up with a different way of doing it. I’ll happily take an intervention if I’m allowed, and then I’m going to finish.