It also means that services are better able to manage demand and, increasingly, capacity and better manage workloads. For example, the bay cluster in Swansea makes prudent use of a paramedic to carry out house calls. That has resulted in people, often the elderly, being seen sooner and not having to wait for the GP to finish surgery. And, in the Llanelli cluster, they've appointed two social prescribers who are helping people access the care they need from a wide range of non-clinical services that are available from the third sector, and that's reduced the call on GP time. Some of the people who've been supported by these services have actually gone on themselves to become involved in volunteering and helping others as a result. Now, to keep people at home and avoid inappropriate emergency admissions to hospital, the cluster in north Powys is making prudent use of the new professional roles of urgent care practitioners and physician associates. I expect the pace and scale of innovation and improvement to continue to increase.

I do welcome the fact that the body of the committee report recognised the wide range of good work being undertaken by clusters. This has developed since the national plan for a primary care service in Wales was published in 2014. However, while I gently disagree with some of the tenor of the recommendations, I note that they fully recognise the progress made by clusters in what is a relatively short period of time. At the outset—and I'm not saying this because there was a different Minister at the time—there was a significant current of antipathy and ambivalence within primary care towards the creation of clusters. People doubted that they'd make any difference, and, worse, many people said they would simply take up time, and there'd be more meetings to attend and more forms to fill. There is now a significantly different attitude and approach to clusters within not just general practitioners, but the broader teams of local healthcare. And, as we heard from Jenny Rathbone, more people want to be engaged and involved in the discussion and the decision making, and the value that brings. For my part, I will continue to encourage clusters to evolve and mature as the right approach to planning accessible and sustainable local healthcare.

I outlined in both my written and my oral evidence to committee, and again in my response to the recommendations, that there are already a number of key pieces of work already under way or planned that address the lines of enquiry and the recommendations. I make it clear in my evidence that we have to be careful to avoid being overly prescriptive about how clusters should develop. We set out to ensure they had the flexibility to respond to local challenges and needs assessments whilst providing a framework within which clusters and health boards operate.

The time is now right for some collective national action to support clusters to evolve. That will be informed by learning and the innovative solutions so far undertaken. So, I've asked the national primary care board to agree a set of national governance arrangements for cluster working by June of this year. And, importantly, I've asked for those governance arrangements to be enabling and not overly prescriptive. I expect them to be designed to support each cluster's individual development journey. And I set out in my response that this work will address a number of the recommendations in the report.

I recognise that committee members will always be disappointed where a Government rejects recommendations, but I would gently say that I don't think it's unacceptable for a Government to reject recommendations any more than it is acceptable for a committee to make recommendations that are difficult or challenging. We, as a Government, have to accept the need to come here for scrutiny and explain what we're doing and why, just as, I think, committees need to know that there is good faith in either rejecting or accepting only in principle.

I just want to turn to recommendation 10. I think there's something here about recommending a national lead to deal with all these local services. I don't think that would actually deliver the sort of improvement that I know Members are generally looking for in training.

And, in response to recommendation 11, I just want to point out that we've made £10 million available on a recurrent basis for clusters to decide how to invest, and I recognise some of the evidence given, both to the committee and that I've heard individually, about some of the variance in the agility with which clusters can use that money together with their local health board. But clusters do take different decisions on how best to use moneys. They have different cluster development plans that they themselves have been involved in designing, and, while it's used to test innovative solutions, I have asked health boards to review their planning processes to ensure systematic evaluation.

I'm trying to deal here, again, with recommendation 13, in part, because that three-year rolling planning process, at cluster and at health board level, has to ensure that unsuccessful initiatives are stopped and successful ones are scaled up and funded from health boards core discretionary resources. I expect that to release funding at cluster level to invest in new innovative projects to drive continuous improvement.

Just on a specific point mentioned by the UKIP spokesperson, I'm happy to confirm that David Bailey, Dr David Bailey from the BMA, will be taking part in the February workshop, so there will be doctor representation there from the ground.

I think we also need to reflect, having had the report and having had the series of responses to the recommendations, that we also yesterday had the parliamentary review, and the significant status and thought given to the role of primary care within that review, and recommendations about planning and about the role of primary care being more specific in the integrated medium term plan process, and indeed changes they've recommended for the IMTP process itself and about the relationship with local government. They're things that we need to be open minded to and to take on board in actually coming to our final response to it.

So, this isn't a point in time where there is a closed door on everything and anything. I expect to see more evidence for the efficacy of clusters in different parts of Wales in the quality and outcomes framework we already have for primary care. That should really help us to understand and evaluate the real impact of clusters. There will of course be learning about what works and what is not working. I think the committee report and its recommendations have been a useful exercise to help take us forward and to actually spread more understanding about the work that clusters are undertaking. 

Having noted the recommendations, I'm pleased again to recognise that a range of them centre on areas of work that we too have already recognised and expect to report back to the Assembly upon. As I said in my response, action is under way or planned, and the committee's report and the wealth of evidence it contains will help to inform our work and our future consideration.