4. Will the Cabinet Secretary make a statement on out-of-hours GP services in South Wales West? OAQ51664

Thank you. I expect health boards in South Wales West to provide safe and effective primary out-of-hours services to respond to urgent healthcare needs when GP surgeries are closed. In South Wales West, that point of contact and access is now the 111 service.

Cabinet Secretary, the BMA recently conducted a survey of GPs offering out-of-hours services. Nearly half of all respondents do not provide any out-of-hours services. Those GPs were asked to identify the main barriers to out-of-hours provision: 64.3 per cent cited exhaustion from daily pressures as the main barrier. In my region, over the last couple of years, four practices have closed and 13 are on the local health board's at-risk list, and a further 12 have indicated that their future is uncertain. If more practices close, we won't be able to provide adequate in-hours services, let alone out-of-hours. Cabinet Secretary, what plans do you have to address workload pressures to enable a greater number of GPs to provide out-of-hours care?

I think the Member comes to the point about the future of local healthcare. It goes back to some of the questions that we touched on earlier on. Trying to run the current system that we have is a recipe for failure for the future and there was a very clear message in the review for all of us to take on board.

In this Chamber, we've had a number of conversations about the future of local healthcare and what it will look like. We talked about the fact that GPs were, more and more, working in an integrated team. Many GPs are already doing that and there are other parts of our GP workforce that are still on that journey. And as we learn more about clusters and the debate that we recently had in this Chamber, we'll learn more about what works, and then part of the challenge the parliamentary review has set for us and the Government in particular is: how do we enable that to happen more consistently across the country? How do we spread learning and share learning and have less tolerance of local practice that is not good practice? How do we make the job easier and better for GPs? That's part of what we need to do and access and triage are part of that necessary conversation as well. We'll actually then have a better job for GPs already in the system. But, of course, with 'Train. Work. Live.' we do have some success in getting more trainees to come into our system as well. So, we need to both safeguard those people already in the system and make sure that their job is enjoyable, that it's done in a way that is forward-looking and not stuck in a past that existed and served us well in the last 20 or 30 years, and at the same time make sure that general practice is an attractive career that keeps people in Wales. Of course, there's a broad conversation now to be had with the wider public on the way that GPs themselves are trained.

Cabinet Secretary, I welcome the 111 approach in south-west Wales because, clearly, that is one way of choosing well, making sure we get the right choices and avoiding going to a GP out-of-hours unnecessarily. But we also need the GP out-of-hours with certain things that are necessary. As such, I'm aware that there are challenges facing these services because GPs aren't coming forward to take on those practices. In my own area, Neath Port Talbot, there's a very serious concern about some of the sessions being covered by GPs and the lack of them coming forward. What is the Welsh Government going to do to ensure that we don't lose that service in the locality? Because the Afan valley people, having to go to a GP— if they end up having to go to Morriston, it's a very long way and they're unlikely to go there by themselves: they end up calling an ambulance. It's not the right way we should be doing it. We should be making sure that the local GP out-of-hours is there for them, in that locality, if needed.

Yes, and I think that's the point: if needed, and who is the right healthcare professional. Part of the success of 111 has been the fact that most of the system that was introduced in England was actually a group of non-clinical call handlers with an algorithm—a script to go through. Often that was rather more cautious and ended up directing people into accident and emergency departments when it wasn't necessarily the right thing for them to do. In Wales, we've spent more time on developing a proper clinical desk. So, you normally have a GP, you normally have a nurse and a pharmacist, and now we're introducing a therapist, and there is often a physiotherapist. So, you get that broader team in actually answering the call at the first port of call as well, and it's been successful. There's been evidence and evaluations that have been undertaken by Sheffield university medical research centre, which shows good practice in the roll-out of 111 here in Wales and a good reason to roll it out. That has to go alongside the extra robustness of having the right healthcare professionals, including, of course, GPs, within the service. I do recognise the fragility we have in some parts of our system here in Wales; that's why getting 111 right will really make a difference so that those GPs who do take part will want to continue to staff our out-of-hours service.