Will the Cabinet Secretary make a statement on the Welsh Government’s progress in bringing forward a long-term solution to the high cost of medical insurance facing Welsh GPs? (TAQ0053)

I thank the Member for the question. We continue to have a constructive conversation with both the British Medical Association and the Royal College of General Practitioners in Wales about the high cost of indemnity insurance. We have agreed with them to review how the market currently operates in Wales to help inform our options for progress. This Government remains committed to finding an answer that works for GPs in Wales.

Cabinet Secretary, I do not doubt your commitment to finding an answer. The trouble is that you’ve been looking for that answer for over two years, if not longer. You offer no timeline, no end date and no commitment to a state-backed solution and no answers. The issue at hand is that GPs have to pay for two elements of insurance. There’s a relatively stable set rate for professional advice and support and a variable, separate rate for clinical medical negligence cover. Changes to the clinical negligence cover model have made this insurance extremely expensive and precludes many contracted GPs from upping their hours in times of need such as winter pressures or stepping in to help another practice where a GP may have resigned or died or retired. The Welsh risk pool offsets cover for managed practices, locums and out-of-hours GP services. Cabinet Secretary, whilst this is a welcome move, by only doing half the job by tackling half the workforce, you risk destabilising general practice. I accept it is an unintended consequence, but I think this highlights why you need to act swiftly, because it makes becoming a GP in a practice far less attractive.

The recent—and welcomed—announcement by the Secretary of State for Health in England that English GPs will be covered by a state-backed solution could further attract GPs away from Wales. Given the disparity in earnings between GPs in Wales and GPs in England, this could be the final straw. So, we have a situation in Wales where you’ve been looking for a solution; you’ve been looking for an awfully long time. Cabinet Secretary, can you please tell us when you’re going to come forward with some kind of proposal, so that we can try to ensure that we do not lose those hard-won GPs that we have? We need to ensure that they will stay with us. We need to get rid of the disparity between being a GP in a practice and a GP that works for a health board, is a locum or does out-of-hours services, and we need to make sure they do not drift across that border. I think that this could undo an awful lot of the good work I know you’ve tried to do in recruiting and retaining GPs to this country.

There are a number of points to respond to there. It’s worth reminding ourselves that indemnity insurance is a general issue across the UK, and it’s been an issue for some time. The need to do something about it has been accelerated by the announcement made by the then Lord Chancellor on the personal injury discount rate. There is a difference between those people that are working directly for health boards and the role of the Welsh risk pool, and those that are working as independent contractors, and we need to recognise that. So, this isn’t something where there’s an easy answer and demanding progress in the here and now will deliver the answer. In committing to a timeline for where we are, we are actually undertaking some proper market analysis. We’ve agreed on the appointment of someone to do that for us. I expect a report to come back into Government by the end of this calendar year, and that will then allow us to have a more detailed conversation about options, moving forward.

I know you made the point about not committing to a state-backed solution. That’s because I’m not in a position to do that. The announcement that Jeremy Hunt made on a state-backed solution is one that isn’t fully worked out. The announcement’s been made with 12 to 18 months to work out what that means, and we don’t know what that means for us in Wales or in Scotland or in Northern Ireland, because we haven’t been given the facility to understand what that means in terms of ‘state-backed’; we don’t have the power to do that here. If it’s going to be a state-backed solution that provides resource with the state standing behind GPs in England, we need to make sure that those facilities are available in every devolved nation. And of course, since the initial announcement it’s also been clear that GPs may need to top up their own premiums in any event. So, there isn’t a certain position that exists in England but an uncertain one uniquely here in Wales. I expect us, over the time that we’re working to, to have an answer for what options exist in Wales over the exact same timescale that people will move within England, and it’s important that GPs understand that message. That’s why I’m pleased to reiterate we have been and are continuing to work constructively with both the BMA and the royal college of GPs. I wrote to them at the time of the announcement and I will, of course, come back to inform Members when there is real progress to report. But this is an issue I take seriously, and I recognise the timescales to act.

The announcement last Thursday by the Secretary of State for Health concerning indemnity arrangements for GPs in England presents a potential challenge for Wales. The Secretary of State for Health plans to introduce a state-backed indemnity scheme for general practice in England, and he has also stated that the indemnity arrangements are a devolved matter. Therefore, the Secretary of State for Health has opened up the possibility of there being significantly different indemnity arrangements for GPs in England when compared with Wales. So, in light of the current shortage of GPs, this is concerning news, really.

If future GP indemnity arrangements are more attractive in England than in Wales, then GP provision in Wales could face several challenges. One challenge would be that existing GPs practising in Wales may move to practise in England. Would graduates also find practice in England a more attractive proposition? In his statement last Thursday, he stated that his department would continue to liaise with the devolved administrations about GP indemnity provision. So, Cabinet Secretary, will you ensure that this promise is kept, and will you point out the specific challenges that we face in Wales? Furthermore, Cabinet Secretary, will you commit to holding discussions with GP representatives, including both the British Medical Association and the Royal College of General Practitioners, about the specific challenges we face concerning GP indemnity schemes in Wales, the recruitment issue, the retention issue, and in light of the proposed state-backed scheme in England, which I think will exacerbate the issues that we have in Wales? Thank you.

I’m happy to reiterate that of course we’re engaging with the BMA, through their general practitioners committee in Wales, and the Royal College of GPs as well. We have been engaged with them in a meaningful discussion in advance of this announcement. And, of course, there will continue to be conversations with the UK Government. But, with all due respect to the comments that have been made about GPs in England being potentially in a more advantageous position, or the previous questions and comments about there being clarity in England, there isn’t. There absolutely isn’t. This is an announcement about a direction of travel and saying there can be a state-backed scheme. The detail of what it really means has not been worked out and is not clear to GP representatives in England or in any of the devolved nations.

And this challenge about what exactly is a state-backed scheme, it really isn’t clear. If the state, the UK, is going to stand behind a scheme in England, but not in the devolved nations, that would be a very big problem, and I don’t believe for one single second that the BMA would sign up to a scheme that uniquely advantaged practitioners in England but not their members in Northern Ireland, Scotland or Wales. There’s a need to have a grown-up conversation about what this means, what our options are here in Wales, how whatever answer we have fits the needs of our practitioners here in Wales and the public they serve, but equally to make sure that the state is not used to particularly advantage one part of the United Kingdom over others. And I would have thought that people in all parties would recognise that that’s the position for us to adopt and expect to hold the UK Government to account—that it is certainly where GPs themselves are in every nation across the UK.

I thank the Cabinet Secretary. The next question comes from Simon Thomas