We now move to the short debate, and I call on Russell George to speak to the topic he has chosen—Russell George.

Thank you, Deputy Presiding Officer. We all know about the crisis that is facing general practitioner recruitment, especially in rural areas. Just last week, we had reports in the media that not a single person had applied for a job vacancy to work as a GP in a Pembrokeshire surgery in the last nine months. There are plenty of further examples from my own constituency of posts being advertised and not being filled for years. I’m therefore delighted to introduce this short debate to highlight an innovative approach to the delivery of healthcare that is serving to alleviate pressure on GPs in my own constituency. It’s a very innovative proposal, which, as far as I can see, and as far as I am aware, is unique to Wales, and only in Llanidloes is this approach being taken. I hope the Cabinet Secretary will agree that what I’m about to say today will demonstrate a practice that could transform primary healthcare across Wales.

Results from my own health survey across Montgomeryshire last year indicated that while patients are generally pleased with their GP practice, there is specific concern about how long patients have to wait to receive an appointment. So, at the end of last month, I was delighted to sponsor an event for Assembly Members here in the Senedd, at which we heard from Dylan Jones, principal pharmacist at the Dudley Taylor pharmacy in Llanidloes, to learn more about how a new model of delivering healthcare has served to combat this issue, looking at workload pressures on GP practices, which are currently facing, of course, the GP crisis that we are aware of, and allowing consultations for minor self-limiting conditions to be effectively managed in community pharmacies, and increasing capacity also, of course, and reducing costs.

GP practices are experiencing an unprecedented increase in demand, and A&E services are also under severe pressure. Indeed, nine out of 10 GPs say that their workload has had an adverse impact on the quality of patient care, with four out of five GPs also concerned about the sustainability of their practice. So, given the difficulties associated with the recruitment of GPs and other practice-based healthcare professionals, I would suggest that continued investment in community pharmacist independent prescribers would represent a valuable use of NHS resources.

With the number of GPs decreasing and practices often run by locums, pharmacies are ideally placed, I would say, to take the pressure off GPs, who deal with 57 million consultations for minor self-limiting conditions every year across the UK, 18 million of which could be effectively managed in community pharmacies. Indeed, you have to wonder why some of these conditions are dealt with by the GP at all, with pharmacies being better placed to deal with sore throats, chest infections, ear disorders and so on. So, in association with the medical practice in Llanidloes, Dylan Jones and Dudley Taylor pharmacy in Llanidloes have pioneered an independent prescribing service, which has recently won UK-wide recognition at the prestigious C+D awards. It is important also to note that Dudley Taylor pharmacy, Powys Teaching Local Health Board and Dylan Jones took a big risk, and they should, I think, be congratulated for the commitment that they have shown in making this success a reality.

Supported by the health board, and the GP prescribing lead at the medical practice, Dr Raynsford, Dylan has qualified as an independent prescriber and the new independent prescribing service began at the pharmacy last December, enabling Dudley Taylor pharmacy to treat patients with acute illness within the pharmacy and reducing the need to visit a GP.

So, it is clear that close collaboration between all parties was key to get this service off the ground. As a prescribing lead at the medical practice in Llanidloes, Dr Raynsford has been integral to the trial, from the very beginning agreeing robust information sharing and referral protocols, which has also allowed the new service to secure access to GP health patient records from within the pharmacy. Communications between the pharmacy and the practice regarding availability and capacity is effective, and this close working relationship has delivered big improvements in patient care.

The service that the Dudley Taylor pharmacy and the medical practice are providing ensures that primary care treatment and advice is quickly available to local people from the community pharmacy on the high street, alleviating, of course, the pressure on GPs and providing a more convenient service for patients, and helping to provide a greater choice for patients, particularly as the pharmacy is able to offer a prescriber service on Saturday, when the GP practice is not open—a service that is highly valued by patients. Patients are directed to the most appropriate provider more quickly, reducing pressure on GPs and increasing GP availability for more appropriate patients, whilst boosting footfall, of course, and supporting the viability of local pharmacies.

The new service in Llanidloes has also resulted in a sustained reduction in the number of patients using emergency appointments at the GP practice. On average, there has been a 23 per cent reduction in GP appointments compared with the same period the year before, and when considering the impact that the service has had on the GP workload, and the pressure at the practice, Dr Raynsford believes that evening surgeries in particular have been much less busy as a result. This has allowed the practice to consider extending the number or increasing the duration of routine appointments, and also allocating more time to providing care outside of surgery, such as home visits to palliative patients, for example. So, by offering patients an alternative to a traditional GP appointment, the evidence suggests that the pharmacy service facilitates a more appropriate use of GP time and allows for a greater focus on patients with complex care needs. In this regard, Dr Raynsford believes that the pharmacy service has been unequivocally successful in meeting its initial objectives, and represents one of the most important primary care service developments of recent years. Feedback from patients has also resulted in universal satisfaction with the service and the quality of care they have received. All respondents indicated that they would recommend the service to a family member, and the pharmacy has also had feedback from patients that has also been very positive, saying that it makes a real difference to them as patients.

The figures also speak for themselves. Ninety per cent of patients have effectively considered or already made an appointment at the GP practice, and 65 per cent would have made an appointment at the GP practice if the pharmacy service was not available. The service is now considered an integral part of the local primary care service in Llanidloes, and is highly valued by the local community. The new service has also impacted on patients’ perception of pharmacy services, with an increasing positive relationship proving to be professionally rewarding.

As a result of the success in Llanidloes, I would ask the Cabinet Secretary whether he would join me on a visit to both the pharmacy and GP practice to see and hear first-hand about the service, to see whether it would be possible to develop this model further, to provide the same accessibility, but also for a greater range of ailments, in a way that truly integrates the GP practices to offer more accessible treatment, care and advice.

However, for all the new initiatives to be a success, a commitment will be required from central Government on whether you and your department will financially support our community pharmacists to pursue additional training to become independent prescribers. Given that the community benefits extend beyond the pharmacy, I would be interested in hearing from the Cabinet Secretary about whether he feels that there is potential for this kind of service to be allocated from a separate pot of money via the primary care innovation fund, so that the benefits are not limited by the size of an individual pharmacy budget, and also so that the new service isn’t top-sliced from existing pharmacy or GP budgets.

Deputy Presiding Officer, in conclusion, I firmly believe that this has the potential to pay for itself over and over again, and it would transform the way in which healthcare is delivered, particularly in rural areas. Delivering cost-effective, high-quality healthcare for the most appropriate provider will benefit the whole NHS, and I look forward to hearing your views on this, Cabinet Secretary, and the potential for rolling this out across Wales.

Thank you very much, and I call on the Cabinet Secretary for Health, Well-being and Sport to reply to the debate—Vaughan Gething.

Thank you to Russell George for bringing this particular topic to the Chamber today, and it is one of those occasions where we are in broad agreement. Indeed, noting that you’ve had a presentation from Dylan Jones, who coincidentally—and I want to place on record my congratulations to him, belatedly, following his recognition at the Welsh Pharmacy Awards as the joint winner of community pharmacist of the year. The Deputy Presiding Officer will, of course, be interested to be reminded that the other joint winner is Jacqui Campbell from Prestatyn, and Pritchards in Prestatyn where I launched the NHS Wales stickers and in a range of other healthcare providers. There’s something here again about understanding who’s part of the healthcare team, what those local healthcare teams look like now and what they could and should look like in the future. Llanidloes is one of those examples of where we think that the rest of healthcare providers should look more and more like this, because it’s in line with the direction of travel that this Government is already taking, and the sorts of changes we want to support to help sustain and improve local healthcare as well. It’s fair to say that not every change in this direction are ones that are particularly supported locally at the time, Llanidloes being a good example where not everyone was in favour of the sorts of changes that are now being made. I’m pleased to see that there’s been real movement, and that’s across parties as well, and thinking about the sorts of teams that we’re talking about, the approach in Llanidloes is consistent with the one that was set out within the national primary care plan. I’m thinking about something that Lee Waters said in the Chamber as well about the approach being taken in Kidwelly, where a difference in the model of care has been really important in sustaining local healthcare rather than seeing it collapse, and only and solely being a focus on local GP services.

I think it’s fair to point out some of the underpinning principles within the successful Llanidloes programme. The first is collaboration, because the health board, the GPs and the pharmacies had full and equal roles in developing the new service in Llanidloes. There’s something there about local stakeholders coming together, not just the power to agree, but actually a shared recognition of the risks in not agreeing what the future could and should look like, and these are almost always people who live within the communities that they serve. So, there’s a real direct interest in seeing the services continue successfully. We know that patients are satisfied with the service. They’re seen quickly and feel that they’re efficiently dealt with. Space has been created for GPs to spend more time doing what only they could and should do as well, in particular seeing people with complex needs. But also the community pharmacists are recognising that it’s professionally rewarding. There’s a recognition with other healthcare professionals that there’s more that community pharmacy can do as well.

There are two other points I would make. There’s one about information sharing, and what we’ve been able to do to enable the wider system to share information safely, in particular community pharmacies being engaged in a network where they can see a version of the GP record. That’s really important, and I’m delighted to confirm that we’re ahead of where we want to be in Choose Pharmacy in the roll-out to community pharmacies across Wales. I indicated that by the end of March 2018 I expected half of our community pharmacies in Wales to be online. We are already over half at this point, so we’re five to six months ahead of where we expected to be. That’s a real success story, because people recognise in examples like Llanidloes and other communities within Wales that it’s been a real benefit to everyone within the local healthcare community, but particularly a real benefit to local citizens. And, yes, the other part includes independent prescribing and, of course, there are a range of community pharmacies who are already independent prescribers. We seek to encourage a range of other people in addition to doctors to have the ability to be independent prescribers, using their clinical skills to do so. There are a range of nurses who can do so and a range of other healthcare professionals—pharmacists, therapists and others—all within their own clinical competence. So, there is a collaborative and multidisciplinary approach to be taken. That’s a key feature of not only what’s happened in Llanidloes, but more broadly in the national Pacesetter programme for local healthcare. And, of course, that’s supported by a fund of £43 million, including £4 million that is in that national Pacesetter programme, and there are many other examples across Wales of what that looks like, either within or outside that programme. Part of my challenge and optimism about the service is that we do have examples of what is working, improving local healthcare for the people that work in those local healthcare teams, but, crucially, for the citizen as well. And for all the challenges that we face, in addition to other nations within the UK, we have good examples and are able to say, ‘This works in Wales already.’ There’s an example in rural Wales that works, and we really should be able to roll that out in different parts of rural Wales. The same with Valleys Wales, urban Wales as well. And, actually, there’s lots of learning to be taken already. Our consistent challenge is how consistently and how rapidly we’re able to do that across the country.

And I mentioned earlier the Choose Pharmacy platform. That was a deliberate choice to be made. NHS Wales Informatics Service, often maligned, but they helped to develop the new IT platform, and the Welsh Government then invested nearly £800,000 in making that available. In addition to that, we have systems in hospital that allow modernised patient information to be transferred between the GP and the hospital as well. So, we really are doing more to share information, but we still want to do more, we still want to move quicker than we currently do.

Will you take an intervention?

I will, yes.

I had a fascinating visit to a community pharmacist in Burry Port the other week, and I was disappointed that the computer system the pharmacist has does not speak to the computer system that the rest of the NHS uses, and these kinds of digital barriers are stopping the potential this model has.

Indeed. There is more for us to do about making sure we have a fully joined-up system. And there’s something about having a platform to allow the sharing of the record, and then having what are currently independent businesses having their own platforms that can actually talk consistently with them. As we continue to develop our digital platform within the health service, we do need to make sure that we have things that are consistent between the different parts of our system. It’s not an easy challenge, but it’s something that we expect as part of what we want to achieve. And, equally, I know, Lee, you’ve made points before about catching up with public expectation, because most members of the public already expect pharmacy and their local GP practice to be able to talk to each other on a digital platform. They expect the hospital system and their local healthcare system to be joined up as well. So, we’ve got a lot to do to catch up. And I recognise the point. In fact, I met pharmacists from Burry Port in a recent day with the health board, and with the university, about what they’d already managed to do and the further innovation they wanted to see take place as well. And, actually, seeing that innovation take place, and it being successful, is part of what gives me real encouragement about the future. Things are happening, and I’d rather have the challenge of, ‘How do we make that more successful across the country?’ rather than, ‘We have no ideas and we don’t know what to do.’

There are, of course, opportunities for community pharmacists to train as independent prescribers, as Russell George asked, and I’m happy to see that supported more generally, in addition to seeing a greater contribution to be made by community pharmacists, and thinking about how we do that with the staff, with the people, with the workforce and, of course, the platform to allow them to do so as effectively as possible.

The common ailment service, which is now being rolled out on the Choose Pharmacy platform, is important in itself. It takes pressure off GPs, gives the citizen more options, and that should then mean that we have other things that we can do, including chronic conditions management and others as well. So, I see it as a start of having a trusted platform to roll out, and then there is more that we could and should do, and I’ve made those comments previously in this Chamber and beyond.

I want to go back to your point about continuing to invest in community pharmacy. And I’m really pleased and proud of what we’ve been able to do in Wales. Everyone knows we face difficult choices, and I won’t make party political points about the Welsh Conservatives at least, but there are difficult choices to make. We know there is less public money available. The Welsh Government has a smaller budget in real terms, and we don’t really expect that to change in the budget round that we’re expecting in November. So, the choices we make are even more important. And I made a deliberate choice to continue to invest £144 million every year in community pharmacy. Across our border, in England, there have been cuts of 7 per cent made to the community pharmacy team. Now, that’s a difference in choice. That’s part of devolution being different, but part of the reason that I chose to do that was that I think there’s more that we can get from the community pharmacy network. And I want to see the network sustained, and to see that used in a different way. And if it can’t maintain the investment in the service, we may well see some pharmacies not existing anymore, not because there’s a quality argument, not because there’s a useful agglomeration of pharmacies locally providing a better and more robust service, but simply because the money wouldn’t be there for that to take place.

And that’s why the roll-out of the platform matters, but also there’s something for something in this as well. Having made a deliberate choice not to cut that investment in the community pharmacy system here in Wales, there’s an expectation that we’re seeing more quality in what’s delivered, and not a payment by volume, by prescribing and by dispensing, but actually a payment in the ability to deliver more quality in the care that the community pharmacists actually provide. And that should make it a more interesting place for them to work. It’s, in some ways, not dissimilar to the conversation with high-street optometrists who want to be able to do different things. And the way we’ve rolled out services into high-street optometrists made the job more interesting for those people, and it’s a better use of our resource across the system—better for GPs not to have people turn up with eye care problems when they’re probably not the right person to see, a better job for the optometrists to do themselves, and actually, for the citizen, more rapid access to the right healthcare professional within their local community. And that’s more of what I expect to see within our system right across the country.

That’s also why, from this month, I’ve also made available £1.5 million specifically to go into that pharmacy quality programme, and that will support collaborative work between pharmacies and other local healthcare providers to make sure that the advantages that we currently have are made real. So, that’s the direction that this Government is setting and that’s the environment that we want local healthcare to be provided in. I think Llanidloes is a good example of what we could and should see more of in the future, and more that we can learn about what to get right and, equally, things that won’t go right and mistakes that we shouldn’t repeat in other parts of our system.

So, there’s much that we can be proud of and much that I’m proud of within our system here as well. And I look forward to working alongside community pharmacy and other healthcare professionals to deliver the very best possible healthcare, even within the current constraints that we all know we operate within.

Thank you very much. That brings today’s proceedings to a close. Thank you.

The meeting ended at 18:51.