Item 4 is a statement by the Minister for Health and Social Services: access to primary care services. And I call on the Minister, Eluned Morgan.

Diolch yn fawr, Dirprwy Lywydd. Today, I am pleased to provide an update on our programme for government commitment to delivering better access to doctors, nurses, dentists and other health professionals in primary care services.

At the outset, I think it is important to acknowledge that the demand for primary care services outstrips capacity, which undoubtedly provides a challenge in terms of delivering on our commitment to improving access to health professionals, particularly when our budgets are so stretched as a result of long-term austerity and inflationary pressures.

The backlog created by the COVID-19 pandemic continues to impact on waiting times. But, despite this, we all know that the numbers of people in Wales supported by our health and care professionals on a weekly basis is staggering. They are dedicated to providing the best quality of care to all who require it, prioritising on the basis of clinical need where necessary. But we know there's a need to do more.

Our primary care model for Wales is about people accessing the right care, from the right professional for their specific needs, as close to home as possible. Primary care services are integrating, bringing together GPs, nurses, pharmacists, allied health professionals, dentists, optometrists, and other local services, co-ordinating access and effectively using everyone’s expertise and time.

Whilst working together to deliver services, we also want front-line health professionals to collaborate through the primary care clusters to help plan services that better meet the specific needs of their communities. To strengthen their voices, professional collaboratives have been established over recent months for GPs, nurses, pharmacists, optometrists and allied health professionals, and dental professional collaboratives are next. This transformation is underpinned by a programme of contract reform, which provides the legislative platform to accelerate patient access to primary care health professionals. This aligns to 'A Healthier Wales', and is founded on the key principles of prudent healthcare.

In Wales, we promote a digital-first approach, and I am confident that we will be making significant strides in this area in the next few months and years. Patients can get a range of advice and information from the NHS 111 Wales website, including access to 76 symptom checkers. During January, there were 423,600 visits to the NHS 111 Wales website, with 18,600 completed symptom checkers. And I am particularly pleased that the 111 service is now being extended to mental health support, with the latest 111, press 2 service having been switched on in Betsi Cadwaladr University Health Board last week.

Where patients need to contact their GP practice, there are initiatives in place to ensure consistency of access across Wales. But we know many people still find it difficult to make a timely appointment to see a GP. That is why our access commitment, introduced in April last year, requires practices to adopt a planned approach to meeting patient need, moving away from the release of all appointments at 8 a.m.. We want to see this way of working become a future contractual requirement for GPs, and I am pleased to say that our initial phase of access standards will be contractually mandated from next week.

With respect to dentistry, we want to reach a position where everyone in Wales who wants access to NHS dental care can get it, but this is not going to happen overnight. On the whole, dentists are independent providers. We are promoting a new way of working, and it takes time to train the relevant workforce. We are working with health boards, who have the responsibility for the provision of NHS dental services, to address gaps in service provision through their operational plans. The overwhelming majority of dental practices are now working under the principles of dental reform, focusing on prevention and needs-based treatment. This is creating capacity for more patients to access NHS dental provision. During this financial year, over 155,000 patients who have historically struggled to get an appointment have now received treatment. From 1 April last year, £2 million of additional recurrent funding was made available to improve access to NHS dentistry across Wales. Health boards are investing this funding in NHS dental services to address local needs.

As part of the reformed contract for our community pharmacies in Wales, since April last year, pharmacists have been able to prescribe and supply medicines for an extended range of conditions, providing increased access to services for the public, and relieving pressure on GP and other NHS services. Pharmacists can now provide treatment for common minor ailments, they can give access to repeat medicines in an emergency, they can provide annual flu vaccinations, emergency contraception, and some forms of regular contraception. And these services are available in 99 per cent of pharmacies across Wales, and they're all provided free at the point of need.

In optometry, we are already expanding clinically focused provision in primary care. That's being done by moving the delivery of some eye-care services from hospitals to the community, where there is a skilled workforce with the capacity to meet increasing demand. Before some aspects of the reform can come into force, some changes will need to be made to regulations, and, of course, we will be consulting on those proposals. In the meantime, the roll-out of services, utilising optometrists with higher qualifications, such as independent prescribing, glaucoma and medical retina, is under way, using existing legislative directions. We recognise that these service pathways will have the greatest impact in terms of supporting specialist hospital eye-care services.

We are also making good progress in terms of providing direct access for patients to audiology pathways without referral by a GP or another health or social care professional. To facilitate this change, we are engaging more with the third sector and community heath councils, establishing capacity in audiology services via robust workforce planning.

Access to allied health professionals in primary care is also a priority, and this continues to be progressed through the strategic programme for primary care. In January, I announced an additional £5 million to increase the number of allied health professionals and to improve access to community-based rehabilitation to help people remain active and independent.

The commitment in the programme for government to invest in a new generation of integrated health and social care hubs will play an important role in helping to build community capacity. Through our new capital investment fund, we are beginning to see proposals come to fruition, including the newly completed Rhiwbina well-being hub, which will provide people with easy and seamless access to a wider range of health, care and well-being services closer to their homes.

There has been further investment for community nursing, namely just under £3 million since 2021. This is to take forward the learning from the neighbourhood district nursing pilot schemes. Supporting this, the electronic scheduling system enables district nursing teams to ensure that their service can provide patients with access to the right nurse with the right skills every visit. 

Across all of these services, ensuring equity of access is vital. This Government recognises the need for a specific focus on access to services by vulnerable groups, including those who are classified as frail.

We have recently commissioned a piece of independent research to gain insight from the public in Wales around accessing primary care services and what good access means to them. The views of the public are extremely important as we work to progress policy that supports their primary care needs. 

Lastly, I would like to acknowledge my thanks to the professionals working in primary care. Without their dedication and flexibility, the services that I have highlighted could not be delivered and transformed for the well-being of people across Wales. Thank you.

Can I thank the Minister for the advance copy of the statement on what is a really important topic, because we see a lot of anecdotal evidence that shows the difficulty in accessing primary care services, and how that drives pressure, of course, on emergency care with lots of people then turning to A&E? Indeed, that was one of the reasons why I brought forward the Welsh Conservatives' GP access plan.

One of the components of that was to upgrade and modernise GP phone systems—that often, I would suggest, don't work for many patients—helping to alleviate long waits when contacting a surgery. I've lost count of the times when I've had correspondence from constituents with regard to the out-of-date methods of trying to make an appointment. We've got that well-known 8 a.m. rush, for example. So, how are you going to support surgeries into the modern world in that regard, Minister? One of these ways could be through an NHS Wales app, so that patients in Wales, like those in England already, could access health records, order prescriptions, contact health professionals and, yes, of course, manage appointments as well. Where are we with this, which I would suggest is vital technology? Perhaps you can give an update in that regard. 

Again, on the plan that I've previously brought forward myself, Minister, have you given any consideration to the suggestion around cutting red tape for GPs so that they can see more patients, by allowing a greater range of professionals to be able to provide medical evidence and certificates, such as fit notes and DVLA checks? If others could do that, it would really free up GPs' time. And what about the improvements in transparency and accountability by increasing the oversight of practices and making health boards collect information on patients? That could certainly be done in a non-burdensome way, using IT, I would suggest. And of course, it's really frustrating for politicians like me, whose job it is to scrutinise the Government, to find that information is just not being collected on matters that are really important to the Welsh people and helping us to make policy judgments. 

Before I move away from GPs, it would be good to know, Minister, if you are happy with the Chancellor's decision to abolish the tax-free lifetime pension allowance, because it addressed in my view one of the driving factors pushing GPs to retire early. This was welcomed, I noticed, by the British Medical Association, who reported the very next day that doctors were already cancelling their retirements to further contribute to the NHS. But I did notice a bit in The Times that reported a dash to retire before Labour reverses this, despite Wes Streeting actually calling for this back in September. So, it would be good to know the Minister's and the Welsh Government's position in this regard, especially in the context that Welsh communities have lost 20 per cent of their GP practices in the last 10 years. 

On e-prescribing, an update on that would be appreciated. Again, in England and Scotland, we've seen that happen there since 2005 and 2009 respectively. Can we have an update on progress in that regard?

I wonder if the Minister also shares my concern that one of the challenges we need to overcome in Wales is the lack of knowledge about different primary care services—an absence of knowledge about what pharmacies and minor injury units can do. And on that note, what is the guidance to A&E units about referring people who are clearly in need of one of these services rather than emergency care in a timely manner? Basically, what I'm saying is that, if somebody turns up, perhaps, at A&E in the Heath hospital with a sprained ankle, they shouldn't be left to go through the system, taking up time and resources; I would suggest they should be then sent away to the more appropriate department straight away. I was just wondering if the Minister shares that view. 

Dentists you've mentioned, Minister. I know in the recent update you provided in that regard you talked about a meeting with the British Dental Association in the next couple of weeks, at the time. Have you had that meeting? Can you update us on what followed that meeting, if it has taken place? 

And finally, you ended your statement by referring to commissioning independent research around accessing primary care services. That's very good, and I very much welcome that. You mentioned that the views of the public are really extremely important, and I agree with that as well. Can you give us any details on the timeline of that work and how can the public engage?

Diolch yn fawr. You'll know that, in relation to access to GPs, we've done a huge amount of work on that over the past few years. In fact, we had some access standards set out, and I'm pleased to say that 89 per cent of GP surgeries are already achieving the access standards that we set out. Those access standards include a commitment to make sure that what is offered by GP surgeries, for example, is a blended model of different ways of accessing. It may be that there'll be an opportunity for an urgent on-the-day booking, there'll be prebookable appointments, there'll be telephone consultations available, there'll be digital contact available. The whole point is that there's a broader way of accessing GP surgeries, and that face-to-face contact would depend on the clinical judgment of the GP. Up until now, that has been effectively a voluntary approach, but in three days' time that will become a requirement. I'm hoping that, for those laggards who have not got rid of the 8 a.m. bottleneck, for example, we will see some shift in those from 1 April.

When it comes to the NHS Wales app, it's been very carefully tested. It's live, but for a small group of people, already. What we didn't want to do is to see what they did in England, which was to launch the app and watch all of the GP surgeries just switch it off, so actually your ability to use it was quite restrained. We're taking it very, very carefully, but I'll have some news on that imminently.

In terms of improvements and transparency and making sure that the voice of the patient is heard, of course there is access now to the community health councils. That is the voice of the patient, and of course, that, from 1 April, will be turning to the new patient voice facility, Llais, so hopefully people will know that they can access that as a way of letting the NHS know if they're dissatisfied with the service.

When it comes to the abolition of pension allowance for doctors, we actually lobbied for this. I was very clear that we had to do something to try and stem the flow of doctors retiring early, so we're pleased to see that. Whether it needed to be extended to everybody in that particular tax bracket, I'm not sure about that, but certainly we've welcomed it in relation to the NHS.

We've got more GPs than ever. When it comes to e-prescribing, you will see some changes on that this summer, at the GP level. And of course there are different ways, as you say, of accessing primary care services. One of the things you will have seen, and you will have seen it because you'll have been living in a cave if you haven't seen it, is the 'Help Us to Help You' campaign, which tries to direct people to the right facility for them. And obviously there's also the 111 service that directs people. Very few of the people who phone 111 are directed to accident and emergency.

I did have a meeting with the British Dental Association. There are clearly a number of issues that we still need to iron out with them. We do need to make sure that we perhaps give a much clearer picture of what's coming their way and that we discuss that with them earlier in the process. I have asked the head of dentistry for Welsh Government to continue with that discussion and I've asked for a follow-up, just to see how far we get on that in the next week.

May I thank the Minister for her statement? Perhaps the most significant thing is the fact that a piece of research has been commissioned by the Minister recently to try and better understand what people's experiences are in accessing primary care services, and what does good access mean to them. It's very important, I think, that we should understand this, because so often the patient experience as it's reported to me and many of us, I'm sure, as Members of this Senedd, is very different to what we're told officially.

For example, constituents will often ask me, 'Why don't GPs see people face to face?' Well, of course, GPs do see patients face to face, and indeed GPs continued to see people face to face throughout the COVID period, but there is this perception that it's more difficult to access a face-to-face appointment now. Therefore, I'd like to hear from the Minister about the work that's being done in order to provide clarity to people on the kinds of services that they can expect face to face within their surgeries, so that they do have a realistic idea of what exactly the expected standards from Government are at the moment.

I agree entirely with what the Government is trying to do in terms of talking about primary care in its broadest definition. People still talk about 'going to see the doctor', but very often they are accessing a health service, and that's why it is so important that people understand all of the services available through pharmacies and so on. I'd like to hear from the Minister about the kind of investment that the Government is making or considering in order to tackle that educational challenge, which clearly needs to be overcome, because it's only if people understand the different ways that they can access health services will they start to take advantage of those services available in alternative ways and more sustainable ways.

One other concern that I have, in turning to the dentistry element of the Minister's statement, is that the Government, whilst admitting there are challenges, is trying to give the impression that services, generally speaking, are in a good place in dentistry at the moment. Having spoken to dentists and many dental patients, I don't feel that that is a realistic reflection. I truly believe that there is a crisis in dentistry in Wales at the moment. We've touched upon that here in the Senedd Chamber a number of times in recent weeks and indeed in recent years. I would ask for a change of tone from Government in discussing dentistry. The First Minister once again during First Minister's questions today emphasised the million people who've had access to dental services over the past year. Of course, there are positive statistics that can be referenced to, but unless we realise that we are in a period of crisis, then I fear that that urgency in the Government response won't be there.

And finally, following the Minister's reference to the community health councils in her response to the Conservative spokesperson, I have one specific question on the North Wales Community Health Council. We know that we are in a very challenging period in terms of health and care provision across north Wales. Betsi Cadwaladr health board has been put back in special measures. I would argue that it's more important than ever that we have a community health council that truly understands that community and can respond swiftly, for example making no-notice visits and so on. So, isn't there a strong argument for enabling the North Wales Community Health Council to continue for the time being whilst we are still facing these challenges in Betsi Cadwaladr?

Thank you very much. I think it's important for us to consider what access means to people and what their direct experiences are, so thanks for recognising that that research is ongoing. I think that perhaps we do need to help people to understand that what has happened historically in terms of having access to GPs isn't necessarily the way that things will work in the future, partly because it's not good use of our GPs. That's why we have to divert people to people who are going to treat them with more expertise in one area or another that is more appropriate for them. That is a change, and I do understand that is a difficult one for people to understand, but I do think that that's the change that we need to see.

What we hope to see is more co-ordination on a cluster level, so the GPs and so forth will work with the allied health professionals and others who work in that area, and with pharmacies and so forth, and they will start to collaborate much better than they have in the past. That is working well in some places, but evidently we have to go further.

Regarding access, I think it's interesting because, very often, we hear a lot of noise about people who don't get good treatment, but a lot of people come up to me and tell me how much they like the e-consult model, which is working very well for many people, particularly those who are in employment. They don't have time to go and see GP and they like having that access. So, things are working better for some people than others, and I think we have to acknowledge that.

We have spent millions on trying to get people to understand that there are other ways of obtaining access to treatment. That's why the 'Help Us to Help You' campaign is to be seen everywhere. It's been very visible. It's difficult to escape from it. I think that that has worked well, and it does provide information to people that pharmacies are available, that 111 is available, that urgent primary care centres are available and that there are lots of other places that you can go to instead of the GP. I think that that has started to work well, but we need to just keep on reminding people. Once people understand that for the first time, they will hopefully pursue those options in the future.

In terms of dentistry, I do acknowledge that there is room for improvement, but I do think that things are improving. So, we have a long way to go, but we are on the right track, and I think that that's important. But, what's clear is that we can't just turn things around overnight; these things take time in terms of training people. That's why I think it's difficult, particularly when we're trying to change systems. What we want to do is to use more people such as dental therapists, and that's why we're opening up a greater number of centres in places such as north Wales. 

In terms of the CHCs and the new group, Llais, I do think that it is important that the voice of NHS users is heard clearly. There's been a lot of preparation in terms of moving from the CHCs to Llais, so there is a lot of preparation to do. The majority of the people who worked for the CHCs, they will be TUPE-ed over, so they'll be the same people, but the system is going to be slightly different. So, I do acknowledge that it's important that people do understand that the system is going to change and that there will be a campaign that people do understand that this new system will be in place.

I very much welcome the statement today. The access commitment introduced in April last year, requiring a GP practice to adopt a planned approach to meeting patient need, moving away from the, 'Release all appointments at 8 a.m., and if you happen to be eighty-first, and they're only taking 80 appointments, then tough, no matter what was wrong with you'—. But how is this being implemented? What is the role of the health board in ensuring that it is implemented?

Last week, I raised a problem that a constituent had had in getting access to primary care. To quote, 'We have called Llansamlet doctors for an appointment for my grandfather every day, twice a day, since 27 February, for an appointment due to a chest infection as he has chronic obstructive pulmonary disease. On 10 March, he accessed a GP, and immediately was sent to hospital'. Does the Minister agree that, until we get primary care working well at all surgeries, hospital admissions will go up? Also, will the Minister join with me in congratulating GP surgeries such as Clydach in the Cwmtawe cluster in Swansea that provide excellent service to all their patients?

On dentistry, after Brexit, we lost in Swansea European Union dentists. Was that true for the rest of Wales?

Thanks very much, Mike. You're absolutely right; there are some GP practices that are performing much, much better than others when it comes to access. One of the things I've asked my officials to do now is to start getting a lot more granular in terms of where we are hearing the complaints over and over and over again. Because some are performing really well, and as I say, 89 per cent of them are honouring the access commitment now, but that means we've got to chase down the rest of them. But, from April, as I say, it won't be a voluntary approach; it will be a part of their contractual obligations. So, it will be much easier then to push people to deliver on what we're expecting of them.

You're quite right in terms of EU dentists. Certainly, we saw a lot of them returning after Brexit, and it's left a hole. It's left a hole; it's another legacy of Brexit. And, again, that doesn't help when it comes to trying to get people to fill up these spaces. They just don't exist; you can't switch on a dentist overnight, and the ones we had, a lot of them have gone home. I can't be responsible for that. I can be responsible for a lot of things, but that bit, I can't be responsible for it, and it's going to take a while to train up the next generation.

The performance of primary care is obviously a really complex issue, because if you're serving a deprived population, it is likely that the demand on your services is going to be much greater than in an area where people can afford to simply go to the pharmacist and buy whatever it is they need. So, I think—. I appreciate that the 8 o'clock in the morning call is incredibly stressful for very vulnerable people, particularly those who find it difficult to use their mobile phones. But I did see some really excellent practice in one of my health centres, where the senior receptionist committed to ring the patient at 8 o'clock in the morning, knowing that they needed to be prioritised for some of the limited available spaces. We cannot expect GPs to run on a treadmill even harder—that is the path to burnout. So, it definitely needs human beings to be involved to prioritise urgent need over the worried well. But I think excellent work is obviously being done, Minister, and the better use of pharmacists and optometrists on the high street. And the 111 service—wasn't it great that we didn't rush into trying to replicate what they were doing England?

Jenny, you need to ask your question now, please.

So, my two questions are really around community nursing. I see that you're committing about £3 million to it, and the electronic scheduling system is very powerful in saving senior team leaders' time. But do we not need multidisciplinary teams involved in community nursing, because we can't get all the district nurses we need, therefore we've got to do things differently? So, that is my main question. Thank you.

Thanks very much, and you're quite right, and I'm going to just pay tribute to the receptionists who very often have a really tough time from the public. And, actually, I do hope that the public will be respectful to receptionists who have a very difficult job, especially when you consider that, in December, there were 400,000 contacts in one week, I think it was, to GP practices. So, this is a huge, huge amount of contacts being made to GPs.

But just in relation to pharmacists, well, we're well ahead of what's happening elsewhere in the rest of the UK when it comes to pharmacies, and, of course, we've got that community pharmacy contract. And what's great is that now, we have 704 pharmacies providing treatment for common ailments, emergency contraception and other issues. The key thing for us to understand is that we're now taking that even further. So, we're trying to get them to prescribe on top. Because these people are highly, highly skilled, and it's now about using their skills to take some of that pressure off GPs. So, by the end of this year, we're expecting one in three pharmacies in Wales to be able to deliver that prescribing service, so I think that's pretty good news. The 111 service has been exceptionally successful and hopefully, now, people will understand that the 111 'press 2' service for mental health is also available.

Just in terms of community nursing—and thank you, again, for championing this, because I know you're a real champion when it comes to this—you're quite right, what we need is multidisciplinary teams, and the No. 1 priority I have given to health boards this year is to say, 'You've got to move more resources from secondary, effectively, into primary care, into our communities'. We have to be working together, with local authorities, building those multidisciplinary teams around the patient and making sure that they're working with allied health professionals. So, I think we're going to see quite an acceleration in that space in the next few months.

Finally, Vikki Howells.

Diolch, Dirprwy Lywydd, and thank you, Minister, for your statement. It's so important that people can access primary healthcare in a timely fashion. So, I'd welcome a little more information about the access requirements for general practice as this transitions to a mandatory basis. From speaking to GPs in my constituency, I'm told that those early morning triage systems allow them to build in far more appointments in the space of a day than would otherwise be the case, but also, of course, I deal with many enquiries from constituents who are frustrated by the so-called 8 a.m. logjam and wish to be able to forward book many more services, such as routine check-ups and blood tests. So, what ratio—what sort of ratio of appointments—would you expect to be held back by GP practices? And how would you see this working in practice?

And finally, as I’ve mentioned previously in the Chamber, I’m really looking forward to the roll-out of 111 'press 2' across Wales, which could also relieve pressure on primary care. What lessons has Welsh Government taken so far from the initial introduction of the service?

Thanks very much. Well, just to note some of the access requirements, some of the things that we’re expecting them to do are to move away from that one approach that’s been there in the past, which is the face-to-face approach. So, we’re looking at blended models. We are looking to make sure that they are able to offer urgent, on-the-day appointments, and that they should also be giving pre-bookable appointments, so, things that, when you phone, you can book an appointment for the future. So, these are some of the things that we are expecting them to do, although not necessarily on the same day.

Telephone consultation is another approach that we’re obviously encouraging and expecting to happen. That is, obviously, something that happens a lot now. There’s not much use being made—although we spent quite a lot of resources on it during the pandemic—of the video consultation that is available to GPs; they seem to still be more comfortable with the telephone approach. But also, that digital contact, the e-consult, is not available everywhere at the moment. I would hope to see that being rolled out as well, including, also, perhaps three releases a day, so it’s not just all of the appointments being given at 8 o’clock in the morning, but actually you’ve got to stagger them throughout the day.

And then, just on 111 'press 2', it’s still very much early days on this. It has been successful, but the key thing for us—one of the key things for us—is to make sure that we can provide that service over 24 hours. Because what we want to do is to make sure that people understand that it’s available, and to take the pressure, again, off people turning up to accident and emergency services. So, intervention early when it comes to mental health is absolutely key, and not letting those issues mount up, which is why I’m hoping that that service will be successful. As I say, it has been rolled out in many places already.

Thank you, Minister.