I was very pleased to have been part of the Health and Social Care Committee when we decided to undertake this inquiry into primary care clusters. Our decision to look at this stemmed in great part from the concerns that other committee members and I had been made aware of through our discussions with doctors in general practice, and we wanted to evaluate this new method of working. I would like to thank the committee staff and all the witnesses who, through their frank evidence, enabled us to challenge the health boards and the Government, and develop a set of recommendations that we believe would enhance the development and authority of the GP cluster network in Wales. 

We heard of so much good practice by GP clusters where there is a strong representation and involvement by other healthcare professionals, such as occupational therapists, physiotherapists, palliative care nurses and mental health specialists. We heard of examples where an idea to enhance services to the patient had been nurtured, received funding, been piloted, shown to be good practice and then either expanded or stalled. In most examples, the barriers to best practice becoming common practice emerged with a similar theme. Health boards wanted to dictate and control the money, thereby stifling the very innovation we needed. There was a lack of sustainability in either people or the money, projects stopped and started, and projects were driven to year end rather than having longevity. 

Not all clusters engage with a broad spectrum of allied healthcare professionals, who had services and ideas to offer, but simply couldn't gain traction. Projects that worked have had to fight to be adopted as common practice by the health board. The checks and balances and reporting overwhelm the green shoots and, of course, there is a self-fulfilling prophecy. If the health boards don't adopt the successful projects and make them their own, then the cluster funding that's tied up in that project cannot be released to act as seed funding for the next innovation.

GPs sometimes found it extremely difficult to engage with the clusters themselves because of the sheer pressure of their case loads, and there was a sense by some allied healthcare professionals and community pharmacists that they could do more, that they were there ready, willing and able but that, in some instances, the cultural shift to stop thinking 'doctor' and utilise their skills and training was hard to achieve.

But where it works, it works well. I would cite examples from the Argyle Street medical practice based in Pembroke Dock in my own constituency, a practice under immense pressure with the largest patient roll in Wales and three doctors down. For chronic conditions and palliative care, they have utilised cluster funding to bring on occupational therapists and palliative care nurses, some of whom are funded directly by the health board and who have become the new front line in helping these vulnerable patients, thereby enabling the doctors to act as a backstop for the more complex conditions.

However, our inquiry, as the Chair has said, did find that it was very much a mixed bag, which is why I find the rejection by Welsh Government of our recommendation 16 so utterly astonishing. We wanted Welsh Government to ensure that there's a clear methodology for the evaluation of cluster work. We believe this would enable best practice to be adopted as common practice more quickly and would help to identify why some projects didn't work and ensure that they were ceased rather than money continually being flung at them. The response by the Government is frankly jargonese, hiding behind the King's Fund, and I've never been able to get my head around any organisation, Government or not, that will spend money without costing that spend—and I reference commentary from your response to our budget report—or measuring outcomes. We must quantify and evaluate. How can we do that without the appropriate information?

Recommendation 11: the Welsh Government have rejected our recommendation that cluster development money should be allocated to individual clusters on a three-year rather than one-year basis, yet the need for sustainability in cluster funding to enable training to get the right staff on board to alleviate concerns over which organisation people work to, the need to pilot, trial, evaluate and adopt—you can't do all that in a year. But a three-year funding cycle at least enables some measure of sustainability. I urge the Cabinet Secretary to review these two recommendations again in the light of all the evidence the health and social care committee took.

I do recommend, Members, that this report is read by all of us, because, given the emphasis on primary care within the parliamentary review into health and social care, clusters are a model for the way forward, but they need to be funded, freed, accountable and, ultimately, evaluated.