1. Will the First Minister provide an update on patients' access to their GP? OQ58800

Llywydd, the general medical standards, agreed with GPs in Wales, are improving access and ensuring consistency across the nation. Achievement has increased year on year, with 89 per cent of all practices now achieving all the standards. Agreement for next year’s contract will see further improvements in access to the whole of the primary care team.

I'm grateful to you, First Minister, for your answer. I've been getting increasing correspondence from constituents in Porthcawl concerned about the availability of an appointment with their local GP. And whilst I understand Porthcawl medical practice is working as hard it can to meet patient demand, they've said, and I quote:

'Diagnostic and monitoring work historically performed at hospitals is being passed to GPs, and, as a profession, GPs cannot cope with these demands from all sides.'

The Royal College of General Practitioners have highlighted concerns that there are 18 fewer practices across Wales since 2020, and the British Medical Association Cymru Wales note that, whilst the Welsh Government is meeting its lesser target of training 160 new GPs each year, it falls well short of the 200 target that the BMA say is required here in Wales. All of this is putting a bottleneck of pressure on practices like Porthcawl, and it's a situation that could potentially get worse in the years to come, as we know that GPs in Wales are, on average, older than their colleagues elsewhere in the UK. So, what steps is the Welsh Government taking to ensure that GP provision meets local demand in a town like Porthcawl, and will you commit your Government to hitting the BMA target of 200 new GPs a year? 

Well, Llywydd, on the latter point, there are 200 places available in Wales for GP trainees. We don't always get to 200, but we consistently attract more than the 160, which is the baseline figure for GP training. The long-term answer, however, is to move away from the single focus on GPs themselves. GPs are leaders of a wider clinical team that works alongside them. And the history over the last decade in Wales has been a successful move to recruit more front-line clinicians in physiotherapy, in pharmacy, through paramedics who practise in primary care, and, of course, advanced practice nurses as well. And the long-term health of primary care does rely on not regarding an appointment with the doctor as the only way in which primary care can be delivered. 

I'm sure the Porthcawl medical practice works very hard indeed. They will be glad to know that, in the negotiations with the general practitioners committee Wales, we have been reducing the amount of repetitive reporting that GPs sometimes are asked to carry out, usually for the purposes of monitoring important clinical conditions. But we can do that in better and smarter ways, and release clinicians' time into doing the things that only they are able to do. 

Emergency primary care units are one of the solutions put forward in order to reduce pressures on surgeries. But, in Ynys Môn, we see that nine of the 10 surgeries that we have on the island have made 278 referrals to the new unit in Ysbyty Penrhos Stanley, while the one surgery that is directly managed by the health board, Hwb Iechyd Cybi, has itself made over twice that number of referrals—562. Does the First Minister agree with me that that's proof that we need to accelerate the process of developing a multidisciplinary health centre for the community of Holyhead and the area?

I have seen evidence over the recent months, Llywydd, about the situation in Holyhead, and I know that the health board is working with local people on the island to try and accelerate the recruitment of new people, and to make what's going on and what's available in Holyhead a part of the service that's available across the whole island. There are some problems, we know, in terms of staff recruitment, but local people are working very hard together to try and improve the current situation.

There are huge variabilities between surgeries' access. There are some excellent surgeries in my constituency, including Clydach and Strawberry Place, neither of which is my surgery. Over 90 per cent of my constituency complaints regarding GP surgeries' access is about one surgery. When people are unable to see a GP, they either go to A&E or wait until their condition deteriorates and are then forced to go to A&E. What can the Welsh Government do to ensure that at least the current median performance is achieved by all GP practices?

I thank Mike Hedges for that question, Llywydd. He draws attention to one of the fundamental facts of primary care, which is that GPs are independent contractors. They have a contract with the board, and they are not directly managed by the Welsh Government or the local health service. However, the good news for constituents of Mike Hedges is that, because of the successful conclusion of the negotiations for next year's contract, then the access standards move from being one of those things that GPs can sign up to, to one of the things that they have to deliver. It is now a fundamental part of the new contract, and that will mean, I believe, that that minority of practices—. Remember, 89 per cent of practices achieve those standards already, and that's an improvement from 65 per cent, Llywydd, in March of 2020, so the great thrust of primary care in Wales has been in the right direction, thanks to enormous efforts of staff. That small minority—that 10 per cent—that's left to achieve those standards, those things will now be easier to enforce because the contract itself will require them to be achieved.

In your initial response to this question, First Minister, you referred to the other health professionals who can play a role in alleviating the pressures on GPs themselves. You may be interested to know that I visited only last week with Jonathan Lloyd Jones in the Caerau pharmacy. It's a pharmacy at the top of a very disadvantaged area—very much that issue of the inverse healthcare law—but what they're doing up there is working with the new community pharmacy contract in Wales. And I have to say I sat in—with individuals' permission—as they did minor ailment diagnosis and prescribing, and took that pressure off the GPs, but were liaising directly with the GPs, and sharing the data information as well, with the patients' authority. What a way forward that is. So, can I ask him for his assurance that we'll keep on exploring these innovative ways not only to relieve pressure off GPs, but also to promote the health and well-being of those in some of our most disadvantaged communities?

Llywydd, I thank Huw Irranca-Davies for that question. I think the promotion of community pharmacy has been something that has been agreed across the Chamber here, over the whole of the devolution period. We've always believed that it was a resource that could be made more of, and, over the years, we have seen community pharmacists in Wales absolutely expand the range of services that they provide, to agree to a modernisation of their contracts, to make sure that the services that that very highly trained workforce is able to provide as part of the primary care family is available right across Wales. And I think it's a real tribute to the people who work in the sector that they have been so willing to play their part in the modernisation of the service in Wales. I'd say this, Llywydd, that, in Wales, we continue to have just over 700 community pharmacists. They're on high streets in every part of Wales, whereas in England there has been a significant decline in the number of pharmacies, and that is because the regulations passed in this Chamber have protected the high-street position of community pharmacies, allowing examples like that highlighted by Huw Irranca-Davies to thrive and expand.

It's not just community pharmacists either, Llywydd, thinking of the original question. I was visiting a GP practice in the last few weeks and they were celebrating the fact that they had just recruited a pharmacist to come and work directly in the surgery and were explaining to me the number of repeat visitors that they will now be able to have seen clinically appropriately and quickly by that extra resource. So, I entirely agree with the point that was made, both in the community and directly within primary care, that the contribution of pharmacy is fundamental to the way we shape the service for the future.