1. Will the First Minister make a statement on the provision of GP locum services in Wales? OAQ52065

Yes. Independent general practitioner contractors and health boards will employ GP locums where there is a service need. GP practices must ensure that they are appropriately qualified and registered.

Thank you very much indeed. Well, in 2014, the chair of the north Wales local medical committee wrote to Members calling for urgent action to tackle a growing crisis unfolding in general practice. In 2016, the vice-chair of the north Wales local medical committee wrote to Members saying that they were very aware of how precarious general practice is in north Wales, with some areas, such as Wrexham, at risk of losing more surgeries in the very near future. And, of course, Gresford is now under threat. Last week, new Welsh Government figures showed the number of registered GPs working in Wales at its lowest level since 2013, with 83 fewer in 2016 and 2017, with just over half of the GP practitioners leaving the workforce rejoining as locums. How, therefore, do you as a Government respond to the reasons given to me by some locum GPs in north Wales two and a half weeks ago for not working in Wales as being: more affordable medical defence cover for locums doing sessions in England than in Wales, on top of the separate performance list issue; extra bureaucracy when dealing with pension contributions; the curtailment of training links with north Wales medical schools; the 'stress and danger' of working in the Welsh system; and different and inferior IT systems, et cetera, et cetera?

It's true that using the same data source as previous years does give a fall of 83. However, statisticians have found quality issues with the data, which may mean it's considerably lower. And a more complete measure of GP capacity in Wales is to include all GP practitioners, locums, retainers and registrars. Using that method shows that there's a 0.3 per cent drop of about eight since 2016. However, I'm very pleased to say that, contrary to the gloomy impression, which I don't think is at all helpful, given by Mark Isherwood, following the conclusion of all three rounds of our 'Train. Work. Live.' recruitment into GP training posts, the Wales Deanery confirmed the appointment of 144 places, which surpasses the 136 training places available at the beginning of the recruitment round, which compares to 121 places filled following three rounds in 2016. This is an increase of 19 per cent, which I think everybody can be very, very pleased about, and it completely contradicts some of the gloom and despondency we hear from the opposite benches. 

Cabinet Secretary, isn't one of the issues with locums the fact that not only can they earn £800 plus a day without the responsibilities of running a practice, but that the tax system under which they operate means that they can effectively, by setting up as a co-operation, pay just 20 per cent tax and the rest as dividends? And what, effectively, the locum system is actually doing is undermining GP practices. Is it the case that the Government is making representations or having discussions with the UK Government about changing the tax system so that it cannot actually work in this particular way and we actually give support to those who take on the day-to-day, ongoing running of GP practice and the long-term medical provision that we require from our GPs, rather than what is, understandably, people who can see far better terms and conditions and earnings by coming in as locums?

Yes, it's true that the introduction of IR35 in the medical profession has probably led locum GPs to consider their taxation affairs. Taxation policy is not devolved to the Welsh Government, but it does affect, obviously, our GP workforce in the same way as it does across the rest of the UK. It's not absolutely clear how it's affecting individual career decisions by GPs, but there are many other factors currently in play like professional indemnity and last person in a practice liability and that sort of thing. 

Of course, we have a different model in Wales as well to support this, and whilst the independent practitioner model has served us well for many years, many GP practices are finding it challenging to respond in the current situation. So, we are looking at different ways of providing that, including employed practices, and facilitating locums where younger doctors do want the flexibility that being a locum provides. So, we are looking at very different ways of providing that, alongside the multidisciplinary practices that we're also looking to implement in large numbers of practices in Wales. 

Another sign of the pressure on primary care was when those figures last week showed the number of GPs working full-time in our primary care surgeries in Wales hitting a low of more than 10 years. And, I'm sorry, but I'm not as relaxed as you are about that. You said again today, as we've heard from Government in the past, 'Don't worry about the number of full-time GPs; we've got plenty of locums.' Well, I'm afraid that's not acceptable, because what you have in a locum is somebody who will more likely work fewer hours, for more money, and it undermines the sustainability of the NHS. Isn't it about time that we saw concrete steps from Welsh Government to stop the drift towards agency and locum working, and to put primary care on a more sustainable footing for the future?

Well, again, I just disagree with the take that Rhun ap Iorwerth puts on this, because, as I said earlier, there are a number of ways of looking at how many people work as GPs, as locum GPs, as retained GPs, as GP registrars, in Wales. Many of Wales's medical centres are training practices, which are responsible for training the next generation of GPs. And, as I said in response to the earlier question, we are doing very well on our training—we're recruiting more than ever before and filling all of our training places, including in previously hard-to-recruit areas, such as Ceredigion, and so on. So, I don't think it's at all helpful to put the negative spin that you're putting on it, and actually what we really want to do is broadcast the fact that so many people are very happy as a result of our 'Train. Work. Live.' campaign, to come and fill our training places and then go on to work in Wales.