7. Welsh Conservatives Debate: GP practices and funding

– in the Senedd at on 15 May 2024.

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(Translated)

The following amendments have been selected: amendment 1 in the name of Jane Hutt, and amendments 2 and 3 in the name of Heledd Fychan. If amendment 1 is agreed, amendments 2 and 3 will be deselected.

Photo of David Rees David Rees Labour 5:15, 15 May 2024

(Translated)

Item 7 today is the Welsh Conservatives debate on general practitioner practices and funding. I call on Sam Rowlands to move the motion.

(Translated)

Motion NDM8582 Darren Millar

To propose that the Senedd:

1. Notes the Access to GP Practices in Wales report published by the Older People’s Commissioner for Wales, which highlights the importance of GP practices in alleviating pressures on hospitals and supporting patients across Wales.

2. Regrets that in 2012 Wales had 473 GP practices, but as of December 2023, this has decreased to 374.

3. Further regrets that only 6.1 per cent of NHS Wales funding went towards general practice in the year 2020-21 and that less than 8 per cent of NHS Wales funding goes towards general practice at present, which is lower than in 2005-6.

4. Calls on the Welsh Government to:

a) take urgent action to ensure Wales doesn’t see it’s 100th GP practice closure in just over a decade;

b) adopt the BMA Cymru Wales Save Our Surgeries key campaign calls of 11 per cent of NHS Wales funding to be spent on general practice and produce a workforce strategy to ensure that Wales trains, recruits and retains enough GPs to move towards the OECD average number of GPs per 1000 people; and

c) ensure the full Barnett consequential arising from NHS spending by the UK Government is made available for the health service in Wales.

(Translated)

Motion moved.

Photo of Sam Rowlands Sam Rowlands Conservative 5:19, 15 May 2024

Thank you, Deputy Presiding Officer, and I move the motion in front of us today in the name of my colleague Darren Millar. And, Members, the numbers are stark: there are 99 fewer GP practices in Wales today than there were in 2012, and it seems to me that the Welsh Government is doing precious little to stop that number moving to 100. And this is a downward trend that's followed declining levels of funding from the Labour Welsh Government. Currently, less than 8 per cent of NHS Wales funding goes towards general practice, which is below 2005 and 2006 levels. Of course, this is at a time when Welsh Government are refusing to spend the full amount of money from the UK Government on our NHS, and we really are seeing the ill effects of that.

That reduction of GP surgeries hits our communities hard. We've gone from a system of traditional family doctors who know people, who know their relatives and ailments, to a scenario where we have GP deserts, with poor provision putting even more strain on the GP surgeries that do remain. That reality contrasts sharply with the stated aims of Welsh Government.

Photo of Sam Rowlands Sam Rowlands Conservative 5:20, 15 May 2024

We are very used to nice words emanating from Cardiff Bay, Minister, such as the 'A Healthier Wales' plan, which wants to ensure that people stay healthy and independent for as long as possible, and who can argue with that? But the huge waves of GP surgery closures stymie that aspiration. Wanting a move towards primary and preventative care that's closer to home simply doesn't square with the situation that we face now. Our communities are losing GP practices where they are needed most, and as a result, that type of care is further away, and as a result less impactful.

We know this has a particularly negative effect on some of our most vulnerable older people. Indeed, as our motion sets out, the 'Access to GP Practices in Wales' report, which was published by the Older People's Commissioner for Wales, highlighted the importance of GP practices in alleviating pressures on hospitals and supporting patients across Wales. Strong, well-funded GP practices reduce the strain on hospitals and allow older people in particular to live more independent lives. Older people are also the ones who are used to that traditional way of accessing GPs that I outlined a moment ago, and navigating new ways of doing things can be difficult at times for them, particularly when waiting lists are longer and there's a battle to be seen by a GP.

It's clear that many of our residents across Wales are deeply dissatisfied with the way the Welsh Government are running the NHS and our GP practices here in Wales. It's also general practitioners who are less than satisfied with their working conditions. Now, data from the Royal College of General Practitioners found that 67 per cent of GPs do not have the time to take a rest break, which they would need every day, and that 70 per cent of GPs work more than the contracted hours most days. It's no wonder we have a recruitment and retention crisis for our GPs here in Wales. Their data also shows that 25 per cent of GPs in Wales do not expect to be working in the profession in five years' time, and whilst some of that 25 per cent reduction is linked to retirements, the two main reasons given are finding general practice too stressful and having to work too many hours in general practice. So, it's clear that the current system is under severe strain and cannot continue in a way that provides both high-quality care for patients and an appropriate work-life balance for those GPs. It's clearly unsustainable.

But it's not just the GPs themselves that need that support. There are others, of course, who work in our general practitioners' surgeries. An example that comes to mind are our general practice nurses, our GPNs. They are there to provide direct patient care and help patients with longer term conditions, and the Royal College of Nursing has concerns about the workforce numbers there in particular, and wants Welsh Government to make sure that nursing in GP settings is seen as an attractive career option for newly qualified nurses. We on these benches would welcome a long-term strategy aimed at improving the physical, mental and emotional well-being of the workforce, whether they're GPs, GPNs, or anybody else working at the GP surgeries. That long-term planning would give people confidence that they can stay in general practice for years to come and not lose faith in the system. It also applies for a more general workforce strategy aimed at training, recruitment and retention, because those people are vital to a thriving health service, and the things that are pushing them away from general practice should be tackled head-on and fixed so our relatives know they can rely on the system for decades to come. 

With the current situation as it is, I'm seriously concerned that it won't be seen as an attractive career option at all. We are at risk of losing out on lots of talented people who do and can make a real difference in our communities. A significant part of fixing these solutions would be for the Welsh Government Ministers to make sure that the full Barnett consequential that comes from the UK Government is made available for health services here in Wales. But it does require a broader plan and strategy, of which funding is only one pillar, and I use the words of the BMA

'General practice is being forced to try and cope with inadequate resources, an unsustainable workload, and a workforce under pressure across the whole of Wales, with some areas in crisis. Burnout and attrition are impacting upon the profession and exacerbating these issues.'

The BMA's Save our Surgeries campaign aims to tackle these problems and make GP services sustainable well into the future. So, our motion today seeks to adopt these campaign calls, which include 11 per cent of NHS Wales's funding to be spent on general practice, and produce a workforce strategy to ensure that Wales trains, recruits and retains enough GPs to move towards the Organisation for Economic Co-operation and Development EU average number of GPs per 1,000 people.

And on that idea of GP services in future, I just want to address one of the Welsh Government's amendments that's in front of us here today, and that's amendment 3(b). This amendment calls the reduction in practice numbers part of a trend towards larger practices. I do think this is a little bit disingenuous from my Labour colleagues. In reality, what's happening is surgeries are being forced to shut because of funding and staffing problems, and not because of some kind of Welsh Government master plan for larger practices. So, I'd like to know, Cabinet Secretary, perhaps in your response later on, whether you think losing 99 GP surgeries has led to better provision and coverage for the people that we represent across Wales. Or, in actual fact, has losing 99 GP surgeries made things worse? In reality, those remaining practices are under even more strain now, because they're taking on patients from those practices that have had to shut down. That means longer waiting lists, more pressure on GPs and other staff who have a lot more to deal with, and we haven't seen any funding increase to match that extra responsibility. So, it's no wonder that those staff are often feeling overwhelmed. And it goes to another one of the BMA's key points, which is about capacity, which they describe as inadequate, because reducing the number of practices, of course, reduces capacity, and means that staff in those remaining practices are facing a job that they will be less likely to remain in on a long-term basis, contributing towards 25 per cent of GPs saying they'll no longer be in the job in five years' time.

To put it plainly, the number of patients is increasing while the number of GP surgeries and GPs is reducing. It's something that cannot carry on as it is, because we are really approaching a breaking point right now. So, I hope Senedd Members across the Chamber will support our Welsh Conservative motion, which is ambitious, but realistic for general practices here in Wales. Diolch yn fawr iawn.

Photo of David Rees David Rees Labour 5:27, 15 May 2024

(Translated)

I have selected the three amendments to the motion. If amendment 1 is agreed, amendments 2 and 3 will be deselected. I call on the Cabinet Secretary for Health and Social Care to move formally amendment 1 tabled in the name of Jane Hutt.

(Translated)

Amendment 1—Jane Hutt

Delete all and replace with:

To propose that the Senedd:

1. Recognises the importance of general practice.

2. Welcomes progress with the Primary Care Model for Wales which supports care in local communities, closer to people’s homes.

3. Notes that:

a) the number of GPs in Wales has remained stable;

b) the reduction in overall practice numbers reflects a trend towards larger practices as GPs seek to reduce costs and maximise resources for patient-facing activity; 

c) the current recruitment target of 160 new GP trainees each year is consistently being exceeded; and

d) the Welsh Government is working with the GP profession on a programme of contract reform to reduce bureaucracy for GPs and improve patient experience.

4. Recognises the Welsh Budget 2024-25 increased funding for the Welsh NHS by more than 4 per cent compared to less than 1 per cent in England.

(Translated)

Amendment 1 moved.

Photo of David Rees David Rees Labour

(Translated)

And I call on Mabon ap Gwynfor to move amendments 2 and 3 tabled in the name of Heledd Fychan.

(Translated)

Amendment 2—Heledd Fychan

Delete sub-point 4(b) and replace with:

adopt the key campaign demands of BMA Cymru Wales's Save Our Surgeries to restore the proportion of the Welsh NHS budget spent in general practice to 8.7 per cent with an aspiration to increase to be closer to 11 per cent and to create a workforce strategy to ensure that Wales trains, recruits and retains enough GPs to move towards the OECD average number of GPs per 1000 people;

(Translated)

Amendment 3—Heledd Fychan

Delete sub-point 4(c) and replace with:

make a formal request to the UK Government for a comprehensive review of the Barnett formula to ensure fair funding for all budget areas in Wales, including health and social care;

(Translated)

Amendments 2 and 3 moved.

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru 5:27, 15 May 2024

Diolch yn fawr iawn, Dirprwy Lywydd. As we on these benches have highlighted time and again in this Siambr, there is, let's be in no doubt, a crisis in primary care in Wales. At the end of 2023, there were only 374 GP practices left in Wales, a decrease of nine since December 2022. Over the same period, there's been a 0.3 per cent decrease in full-time-equivalent GPs, and an increasing trend in partners handing back NHS contracts due to mounting pressures. And this is a crisis that's been a long time in the making. The total number of GPs in Wales has decreased by more than 400 in 10 years. We are now on the verge of seeing the one-hundredth practice closure in Wales in just over a decade. The total number of practices has decreased by 18 per cent, with our rural communities suffering the brunt of the crisis.

The Government's proposed amendment to this motion suggests that a reduction in surgery numbers is a sort of efficiency measure, something to be welcomed. But I beg to differ, similar to what we were just told by Sam now, as does, indeed, the Royal College of General Practitioners, who've argued that we are not looking at a bigger-practice-by-design model, but a crisis in the sustainability of general practice. We're witnessing a vicious circle of GPs retiring earlier or leaving the profession due to increased workloads, leading to further strain on the remaining workforce.

The workload of GPs continues to increase, and individual GPs are responsible for more and more patients. In September 2022 the average full-time GP was responsible for 2,210 patients, compared to 1,676 in 2013. This represents an increase of 32 per cent in the number of patients per full-time GP, a significant workload increase for each individual practitioner. Meanwhile, a junior doctor enters the workforce earning, as it stands, around £13.65 an hour in Wales. This is all symptomatic of chronic under-resourcing by the Labour Welsh Government, who have failed to even acknowledge the true scale of the problem, and, as reflected in our amendment to the motion, of an unfair financial settlement for Wales from a UK Tory Government in Westminster, which fails to deliver a level of funding for our public services in Wales on the basis of need.

These are arguments that are by now well rehearsed—so, too, is the chuntering from the opposite benches. The responsibility for the multiple crises in our NHS lies both squarely in Westminster and Cathays Park. They are the product of 25 years of mismanagement, exacerbated by more than a decade of austerity. Bold action is needed now more than ever to save the NHS, and we in Plaid Cymru have been clear about what this would look like. We recognise that the problems in our health service run deep and would take immediate action to address the problems in primary care. Alongside reversing a decade of cuts and restoring the general practice budget to 8.7 per cent of the NHS spend, we would work with the profession to develop a retention and training programme, with a view to recruit 500 more GPs over a two-term period. Our ultimate aim, of course, is to reach the Organisation for Economic Co-operation and Development's average ratio of GPs per 1,000 people, but we're realistic—we know that fixing Labour's mess will take time. Janet.

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative 5:31, 15 May 2024

Thank you, Mabon. If you are so concerned, as you profess here today, why didn't you stipulate this as one of your parts of your co-operation agreement?

Photo of Mabon ap Gwynfor Mabon ap Gwynfor Plaid Cymru

Yes, I think it's pretty clear that we don't agree with the Government. I'm not sure if you understand co-operation, but you have to agree on things to put them in a document that you're going to work together on. We didn't agree on this. So, that's the simple reason why it's not there. And also, in addition to restoring the general practice budget, this means working with the sector to develop a training and well-being programme for GPs that would give them the time they need with each patient and to develop their skills. We'd work to ensure that GPs are retained and that working in Wales is an attractive offer for those that want to make a real difference. This would all necessarily be part of a wider package of reform that looks at the organisational culture of the NHS in Wales, being clear about where responsibility lies and ensuring that Ministers are not able to pass the buck for policy failures. It is long since time that the Welsh Government took the necessary measures to protect and reverse the decline in our primary care service. Even to acknowledge the true scale of the issue would be a start. As such, I welcome this debate this evening and look forward to the Cabinet Secretary's response.

Photo of Mike Hedges Mike Hedges Labour 5:32, 15 May 2024

I'm convinced about the importance of primary care in Wales. Firstly, I would like to thank those working in primary care for what they are doing for us as patients. When primary care is working well, then it reduces pressure on all the other parts of the health service. It needs to be readily accessible for patients and needs to work closely with social care providers to reduce the need for hospitalisation. When it fails to meet patient needs, then the default becomes visiting A&E and then waiting to see a doctor there, because you know you might have to wait 24 hours, you might have to wait 18 hours, but you'll definitely see a doctor, and, when you can't do that with a GP, then that's where the system breaks down.

Primary care has not recovered from the merger of primary care and secondary care, which has resulted in the proportion of the budget spent on primary care continually reducing. Primary care services play a vital role within the wider system of health and care in Wales. Services have come under increasing pressure from rising demand and constraints in capacity. Changes need to be made to ensure that primary care services are sustainable and can play the key role that is required of them within the NHS in Wales.

Primary care is about those services who provide the first point of care, day or night, for more than 90 per cent of contacts with the NHS in Wales. General practice is a core element of primary care. It is not the only element. Primary care encompasses many more health service areas, including pharmacy, dentistry and optometry. It is also, importantly, about co-ordinating access for people to the wide range of services in the local community to help meet their health and well-being needs. Vaughan Gething, when health Secretary, identified three major priorities for primary care in Wales: maintaining the sustainability of the sector, improving access to services, and delivering more care in a community centre. Central to delivering these objectives are the GP clusters or primary care networks. There are 64 networks or clusters in Wales, with a population of between 30,000 and 60,000 patients. It is based on promoting partnership and collaborative working. The networks allow general practice and a range of other primary and community care practitioners to get together with their local health board to share community-based services for their population. Where things are going well, a wide range of new services are provided, often using new models of care. Within a cluster will be GPs specialising in different parts of the body. And, going back to the previous debate, there will be GPs specialising in women's health. 

BMA survey evidence showed that 80 per cent of GP respondents had concerns about the sustainability of their practices. The efforts of the Welsh Government to promote recruitment to improve the state of general practice were widely supported, and I also support them. We need to improve the state of general practice. Far too often, we—and I don't exclude Members in here—seem to think that secondary care is, in some way, superior. It is not. General practice is the most important part of the health service, because that's the bit that you're most likely to meet. 

The need to return services to a community setting and improve access is widely acknowledged. Some services, such as the use of pharmacists, better use of home physiotherapists and occupational therapy services and community reablement for respiratory and cardiac conditions build on well-established practice. Social prescribing is also important as a means for primary care to reduce the chance of becoming ill through the better use of non-medical interventions and to influence social determinants. And if we could do one thing, we would deal with the obesity crisis, and that would cause an awful lot of a reduction in the number of people needing to visit GPs.

Within ABMU, they have a home first approach, which is an umbrella term for a range of services to patients, delivered on discharge from hospital, with access to ongoing care and assessment post discharge in a community setting. Home first services offer rehabilitation at home or in a bed at a reablement facility, therapy-only support, medication management, nursing and social worker support, well-being services via the third sector or a complex needs assessment, which includes ongoing assessment in a care home. Again, this is all about working together. The aim is always to deliver a home first ethos for patients and to advocate what matters to them with the teams working collaboratively with all partners, patients and their families.  

The percentage of the health budget spent on primary care has continually reduced, and the percentage spent on secondary care has continually increased. As a first action, can I urge the Welsh Government to give the protection that it gives to expenditure on mental health—i.e. that percentage is fixed—to primary care? That's not one of the headline makers, as this resolution is, but it's something that can be done, it can be done this year, and we can stop the continual reduction in expenditure on primary care. 

And finally, Plaid Cymru continually talk about that everything is wrong with Westminster: why don't they bring us a debate on independence?

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative 5:38, 15 May 2024

I'm sure not many of us were surprised at the Older People's Commissioner for Wales's report that was released just last week, and I think it is also time to seriously rethink our primary care services from the bottom up. We should put on record that the detail you put into your speech there in opening this debate, Sam, was absolutely spot on. We can't afford to lose another single GP practice. 

In 2023, it was indicated that older people's experiences were of suffering immensely, with over 40 per cent of older people aged 60 saying that they were less likely to try and get a GP appointment, access an out-of-hours GP service or request a home visit due to reported NHS pressures. Eighty nine per cent of older people reported feeling anxious about the state of their GP services. The latest report tells us that a significant majority of older people are encountering challenges in scheduling suitable appointments, with approximately two thirds reporting difficulties in contacting or communicating with their GP practice, whether through telephone or even online channels. 

This latest report—sorry. It is not just access that is an issue. Indeed, nearly 60 per cent of older people think GPs have not been effectively communicating with allied services, such as district nurses, pharmacists and secondary care providers, in some instances resulting in missing or misfiled medical documentation. I don't blame the GPs. We've got the most amazing GP practices in Aberconwy, but whenever I speak to any of them, the GPs themselves, their staff, everybody is absolutely under severe pressure and exhausted. And they tell me that this Welsh Government needs to sit up and realise they’re not going to be there forever. Who is going to replace them? It is this disconnect that I want to highlight. These services are fundamentally not equipped for purpose and have not been able to adjust to the demands of our growing and ageing population. What I see at the heart of this is a primary care framework that is out of date, inefficient and unable to effectively build relationships of trust between patient and doctor. And I have to be honest, I’m not actually blaming the Minister to a large degree on some of this, simply because some of these GP practices do run themselves, if you like, rather like a business, and I know sometimes, if things go wrong within that practice, it can be very difficult for us to actually—. Because they’re self evaluating.

We must examine ways in which we can better identify those who may not require an urgent face-to-face appointment. Since COVID, my own practice, now, if you ring up to make an appointment that day, they will say, ‘We’ll get the GP to phone you’, the GP phones you, you explain what the issue is, and he will actually decide—or she—whether you need to come in and see them, or whether they can actually dispense something, dependent on the issue. So, I do think we need to look at modernising our—. We’re too indoctrinated, almost, to believe that you need to see a GP for every ailment.

To begin solving the issue of access, we could look at signposting of patients to online consultation tools that enable GPs and other primary healthcare providers to triage patients in a less time-constraining and resource-heavy manner. A Welsh NHS app would be key here, but bear in mind I think it’s 37 per cent of my residents in Aberconwy do not use the internet—either they have no broadband, or they haven’t got the skills to be able to use it. So, again, we have to be very careful we don’t marginalise our older people. One constituent wrote to me recently that their previous online system in England was excellent, with medical records easily accessible and prescriptions quickly requested. However, upon moving to Wales, they noticed that the lack of an NHS app means that GP practices rely on localised systems that are unable to communicate with other systems, such as health boards, meaning health records about life-threatening allergies, for example, were not properly transferred.

Being able to signpost and engage with patients online is essential to a modern Welsh NHS. However, as highlighted in the report, digital exclusion remains a significant barrier for many of our elderly. We must accept that some of us are just not tech savvy. I’d like to think I am, actually, but there are people that, fair do's, they can’t. So, it’s how the Welsh Government can educate and help, and, you know, systems where we can maybe put classes on again, or really help older people to engage. But there will always be a significant number of people who want to be able to use the traditional methods of contacting their GP. What we should be doing to enable this is increasing awareness of digitalised services.

Photo of David Rees David Rees Labour 5:43, 15 May 2024

Janet, you need to conclude now, please.

Photo of Janet Finch-Saunders Janet Finch-Saunders Conservative

Yes, I know. I know. As funding is clearly the predominant problem for our health service, I think it is time that we shift our focus away from endless funding pledges and begin to take a more holistic, modern approach towards reducing the pressure on our GPs by reforming the system so it is adaptable, efficient and personal, and I believe, though, Minister, that this is where I do believe that you have a part that you could play, and it would be a really effective part for you to play. Thank you.

Photo of Heledd Fychan Heledd Fychan Plaid Cymru

(Translated)

Perhaps I’ll start by responding to Mike Hedges. I can promise you, Mike, that we have had discussions about independence very often put forward by Plaid Cymru, but, if you’re eager for another one, we’ll discuss it in the group next week, and we’re very happy to have that conversation. [Interruption.] We look forward to that, because this is an issue that we are calling for in terms of fair funding for Wales, of course. But this is an issue that deserves our attention.

We would all, of course, know that this is a hot topic, wherever we represent. There have been references made to rural communities. I represent South Wales Central; you would think that access to GP surgeries would be easy for a number of our communities in those areas, but it’s not, and one of the things that we do have to bear in mind is how interlinked access to surgeries is with so many other policies. Particularly, in my region, buses are the major problem. If you don't have access to a car, then accessing a GP surgery can be very difficult, and I'm not talking now about the challenges of getting an appointment—we all know that appointments are very scarce.

But there are two surgeries at the moment in my region that are facing closure: the surgeries in Cilfynydd and Ynysybwl. Nobody else is interested in taking over these two surgeries. They've tried, but no-one is interested. The model has changed, there's a centralisation of services in larger sites, which do have some advantages in terms of providing greater expertise, but for those who are most vulnerable, it's very challenging.

In Ynysybwl, for example, to reach the surgery that people will have to go to, you have to take two buses. If you're in a wheelchair, only one wheelchair can travel on each bus, so they sometimes have to wait. If there's more than one person in a wheelchair, they check, 'What time is your appointment?' So, those things are very challenging. But also, what if the bus doesn't turn up and you reach your appointment late, which does happen very often? Some doctors are flexible and are willing to see that patient, but not all doctors. So, we have to look at the system holistically. I've been talking to the doctors who are facing the closure of Cilfynydd and Ynysybwl and the centralisation of services in Pontypridd, and they urge me, 'Can you improve the bus services?', because they understand these challenges. Taxis are extremely expensive.

But the main thing that we see is how difficult it is for GPs at the moment, the huge strain on them, and why, therefore, they are considering leaving, early retirement and so on, and why more people don't want to take over the surgeries when they become available. We heard from a number of GPs in the Senedd as part of the BMA's Save Our Surgeries campaign, and it was clear how much passion that these GPs had for what they do. They want to do a good job, but we've heard about the challenges already this afternoon when people aren't heard. 

But we must also ask why some GPs don't perhaps hear some of the things that they should hear, and don't act in the way they should. It can be because of the immense strain placed on them, and one thing that became clear to me in talking to those GPs was that they were very honest about how difficult a job it is at the moment, the impact on their mental health, the strain, the pressure as well. We've heard about absences because they see, because of the waiting lists that we have, people's condition deteriorating, people coming back to see them more often, and the pressure that that causes. So, one solution isn't enough here, we're talking about a number of different elements.

But the truth is that we have to see action now. We know what some of the challenges are. There are solutions in these proposals and what we have included in our amendments, and I think that we are all agreed that we want a system that works wherever you live in Wales, that the training is available, that the services are available. It's all interlinked, it isn't just about GPs, but all of the infrastructure that is needed. So, I'm pleased to support, and I hope that there will also be support for our amendments. We have to have fair funding in order to get the public services that our communities deserve.

Photo of Jane Dodds Jane Dodds Liberal Democrat 5:48, 15 May 2024

For my contribution, I wish to focus upon a recent set of visits that I undertook around Mid and West Wales to gather the views of rural general practitioners about the most pressing issues that they face. Firstly, let's look at the blunt demographic realities of rural Wales. According to the Office for National Statistics, Wales has an older population than nearly every single region of England, with my home county of Powys having the highest at 27.8 per cent aged 65 and over.

Rural populations have unique characteristics and challenges. There are the mental health issues around living in isolated areas. There are the unique challenges in accessing timely medical care. In Powys, we have no general hospital, so everybody has to access a general hospital over the border in England. And there are travel challenges as well, which Heledd has just spoken about.

I just want to speak about our farming communities as well. There are particular barriers for them; when farmers fall ill, they often cannot seek prompt treatment from their local GPs because they can't leave the farm—literally. Instead, they must wait for overstretched GPs making lengthy home visits, allowing treatable conditions to deteriorate along the way. And in rural areas, we have a very poor housing stock. Many of those properties are owned by landlords who are very, very reluctant to treat conditions in those homes, which exacerbate those illnesses.

So, I have the following three asks, if I may. Transport has been touched on, but it's even worse in a rural area; there are literally no options. We've heard about the survey from the older people's commissioner: elderly respondents cited the lack of public transportation as a major barrier preventing them from seeking access to GP practices. I would therefore be interested to know from the Cabinet Secretary what conversations you've had with the transport Secretary to ensure that routes enabling access to healthcare are a real consideration in the forthcoming bus Bill.

Secondly, spending in rural GP settings is actually much higher, because of the unique operational challenges that they have with no general hospital being nearby. Local practices that I've visited have informed me that they must provide these enhanced services, such as phlebotomy, which would perhaps be more readily available in urban areas.

Thirdly, recruitment and retention. We've heard a lot about this today, but in rural areas, we had a scheme called the 'targeted enhanced recruitment scheme', which lapsed in February of this year. Rural areas did benefit from that particular scheme, and, in fact, in one GP practice that I visited, I met one of the GPs who'd come through that scheme and decided to stay in that rural surgery, so it was successful. So, I'd like to hear from the Cabinet Secretary what issues she can think of that present the challenges of moving that forward. I think—

Photo of Jack Sargeant Jack Sargeant Labour

I thank the Member and I appreciate the comments that the Member has made today. I wonder if I could press for your support for a fourth call. The conversations I've had with local surgeries are around the deliberate profiteering from landlords of GP practices for no justified reason. Would you support calls for a national conversation, both here in Wales and the UK, to stop that practice, so that already pressured GPs can get on with focusing on their patients, rather than these hefty bills for no reason at all?

Photo of Jane Dodds Jane Dodds Liberal Democrat 5:53, 15 May 2024

I'd like to thank the Member for that, and that was an issue that came up when I visited the GP practices, that, actually, their costs were higher and they had no control over those, particularly, as you say, when landlords would present them with a bill that they couldn't actually meet and that forced them into a particular area. So, thank you for that intervention.

I am going to finish, and I'd like to finish with a call for a rural GP premium. I'd like the Welsh Government to consider how you could enact this. This would actually help stabilise our rural practices; it would attract and retain talent and ensure that our local surgeries can continue providing those enhanced surgeries that our rural communities depend upon. We've heard, haven't we, the reality is that our GP practices, especially in rural areas, are collapsing under immense pressures. I look forward to further contributions, but also to hearing the Cabinet Secretary's view on a rural GP premium. Diolch yn fawr iawn.

Photo of Mark Isherwood Mark Isherwood Conservative 5:54, 15 May 2024

GP practices are not only a local lifeline for patients, but they also alleviate pressures on Welsh hospitals, saving costs for health boards. It has therefore been the worst kind of dumb health economics to progressively cut their share of NHS Wales funding. Of course, this is not new, and  Labour Welsh Governments have form for this over many years.

It's now 12 years since both the British Medical Association Cymru and the Royal College of General Practitioners relaunched campaigns warning that Wales faced a GP crisis, that 90 per cent of patient contacts are with general practice, yet funding as a share of the NHS cake had fallen, and that they had relaunched their campaigns because the Welsh Government didn't listen. It is now decades since a BMA Cymru briefing in the Assembly, as was, at which the chair of the north Wales local medical committee said:

'General Practice in North Wales is in crisis, several practices have been unable to fill vacancies and many GPs are seriously considering retirement because of the currently expanding work load.'

It is now eight years since GPs in north Wales wrote to the then First Minister, accusing him of being out of touch with the reality of the challenges facing them. The Royal College of GPs stated then that general practice in Wales provided 90 per cent of NHS consultations for only 7.8 per cent of the budget—it's even lower now. Prolonged underinvestment, they said, means that funding for general practice has been decreasing compared to the overall Welsh NHS, yet we face the significant challenges of an ageing and growing population.

Consultations, they said, are becoming longer and more complicated, as they deal with an increasing number of patients with multiple chronic conditions. And they said that nearly four in 10 patients in Wales found it difficult to make a convenient GP appointment; 84 per cent of GPs in Wales were worried that they had missed something serious with a patient due to pressures; more than 52 per cent of GPs faced significant recruitment issues; and Wales needed to employ 400 more GPs.

It's now more than five years since a BMA Wales report showed that managed GP practices do not provide value for money. It’s now almost three years since BMA Cymru wrote to this health Minister, now the Cabinet Secretary for Health and Social Care, urging a radical shake-up of the health and care system in Wales, with the chair of the BMA’s Welsh consultant committee stating:

'After repeatedly raising concerns over the last few years that the situation was worsening, we are sadly seeing our fears borne out. If action is not taken immediately to resolve this situation then patients will die'.

Jumping forward, it is no wonder that BMA Cymru's Save Our Surgeries campaign is now calling on the Labour Welsh Government to ensure that 11 per cent of NHS Wales funding is spent on general practice, and that Wales trains, recruits and retains enough GPs to move towards the OECD average number of GPs per 1,000 people.

I was one of several cross-party MSs who attended a meeting on 8 March with north-east Wales GPs, at their request, to hear about the many challenges that they are facing in primary care. They told us that the health board’s managed practices are not providing the same level of continuity of care, patient satisfaction rates, out-of-hours attendance rates, preventative work, or accountability as GMS practices, and that it is in the health board’s interest to support the GMS practice model.

They told us that GPs would like to provide more services closer to patients' homes as part of 'A Healthier Wales'; that they have the expertise to do this, but need political support to shift the funding from secondary care and have appropriate facilities to do so; that they would like to be able to triage patients waiting in ambulances outside A&E departments, which would improve the patient experience while reducing both waiting times and hospital admissions; and that the future of primary care needs to be secured by placing appropriate resources in place now. That’s what the GPs told us.

Convenient access to healthcare from GPs in general practice is key to the future of the Welsh NHS. It is more cost-effective to care for patients in a primary care setting than elsewhere in the health service. By ensuring decent access to GP services, we can help to keep our population healthier for longer, enable more people to successfully manage their conditions in the community, and avoid unnecessary and expensive hospital admissions. But general practice cannot do this without adequate resources. A move from Labour denial to essential action is long overdue.

Photo of Rhianon Passmore Rhianon Passmore Labour 5:59, 15 May 2024

I rise to discuss today, in support of the amendment tabled by Jane Hutt. Earlier this year, I visited North Celynen general practice in Crumlin, within my constituency of Islwyn, and the staff who work there are actually on the front line of our beloved national health service. They tell me first-hand of the exponential and scalic increase in patient demand. They tell me of the complexity of co-morbid conditions post COVID, and the severity of those presentations. And all of this alongside the amazing advances in medicine and patient awareness. In short, we face the perfect storm of retiring GPs and practitioners, and subsequent workforce and capacity shift.

But it's true to say that the elephant in this room is the billions of pounds less that Wales does not receive as a direct result of decisions made by the Conservative Government in Westminster, and it is difficult and demanding for staff. But, ultimately, our practices know, and they tell me, that a great part of this for them is this endeavour that our healthcare is free at the point of care for all, irrespective of wealth. I was told by professionals that tensions still exist in ensuring appointments can be given to patients, and adequate time can be spent with patients due to that demand. 

In April 2022, the Welsh Government established the general medical service access commitment—a pledge that people would have their needs responded to the first time they contacted their practice, without being told to call back at another time. By 31 March 2023, though, 95 per cent of GP practices said that they had achieved this commitment, and so it's vital that that continues and is maintained. So, I welcome the Welsh Government investing £12 million over three years from April 2022 to help GP practices build their capacity through additional staff to support this important commitment, and those other improvements, to access equally. So, the access commitment requiring GP practices to adopt a blended model of access, offering a mix of remote, face-to-face, urgent, on-the-day and pre-bookable appointments is part of that.

Dirprwy Lywydd, you only have to pick up a copy of today's Western Mail and read the letters pages to know how beloved our NHS is and remains. Elaine Ryan wrote, 'Nye Bevan dreamed of a first-class healthcare system free at the point of delivery, so, today, I experienced that Nye's vision's superlative care.' So, let's all support and cherish what may continue for many years to come. But let us in the Senedd be under no allusion, though, that 14 long years of Tory UK Government rule at Westminster has seen all aspects of public life suffer because of the concocted Tory choice of cuts, or, if you prefer, austerity. Thank you, Dirprwy Lywydd.

Photo of Samuel Kurtz Samuel Kurtz Conservative 6:02, 15 May 2024

I'm pleased to participate in today's debate, but, sadly, like all of us, far too many of my constituents are simply unable to receive the treatment and care they deserve. But, before I begin, may I take the opportunity to express my gratitude to all doctors, nurses and medical staff, as well as non-medical staff, who are delivering the best possible care for my constituents, despite the challenges posed by Welsh Government policy?

GP practices are indispensable for local communities and access to them when needed is essential. They quite literally provide a lifeline for people, particularly when travel to other areas of the county is restricted due to illness or disability. Access to GP surgeries also helps alleviate pressures on other aspects of the NHS, most notably A&E departments. In my constituency, we have the Argyle Medical Group surgery in Pembroke Dock, which I've previously raised in this Chamber. The surgery is one of Wales's largest, serving over 20,000 people. Unfortunately, the number of registered GPs has decreased from nine in 2021 to eight. Indeed, on their own website, it says,

'We have fewer doctors working for us than ever before', before going on say that minor illnesses and injuries will be dealt with by other trained medical staff. This, coupled with other issues—the telephone booking system being overly busy at peak times, and access to same-day or future appointments being ad hoc—has resulted in significant difficulties in accessing the surgery. However, I want to put on record my thanks to the hard-working staff at Argyle Street for their dedication to delivering the best quality healthcare possible against a difficult backdrop, not helped again by Welsh Government policy.

This situation is a clear failure of long-term planning by the Welsh Government, as there are insufficient GPs being trained or incentivised, either through pay or conditions, to meet the necessary demand. It is unreasonable to expect same-day GP appointments when funding for practices is insufficient, and so is it right that less than 8 per cent of the Welsh NHS budget is allocated to them? We must heed the advice of the BMA and restore funding for GP practices to historic levels of 8.7 per cent of the health budget, with the aim of increasing this to 11 per cent in the next five years. This will help halt the decline in the number of practices and GPs, ensuring that surgeries like Argyle Street can see an improvement in their circumstances. None of us want to see surgeries to be overworked and understaffed, as it is detrimental to both them and the health and well-being of their patients.

Additionally, we must address the unique challenges faced by GP surgeries in rural areas, particularly in recruitment. Without steady recruitment, rural surgeries close, leaving communities without access to essential healthcare services. We must make roles outside of the major urban centres in Wales more attractive both professionally and socially. We saw this in my constituency at Laugharne surgery, a rural GP practice, highlighting the lack of staff, looking to close. The rural premium that we often talk about is very real when it comes to accessing healthcare. Uniformity and equality of service and provision across Wales is missing.

I'd like to conclude my contribution this afternoon by reiterating my thanks to all staff within GP surgeries for their hard work and dedication in caring for patients across Wales. To those watching or not watching, I want to tell you that you are not alone, and we on these benches recognise your needs. If others in this Chamber recognise their needs too, then I urge you to support the Welsh Conservative motion this evening. Diolch, Dirprwy Lywydd.

Photo of Cefin Campbell Cefin Campbell Plaid Cymru 6:06, 15 May 2024

(Translated)

As the Cabinet Secretary knows full well, in Mid and West Wales the challenge of keeping rural GP surgeries open is intensifying, and it's the change in the social fabric of our rural communities that is one of the main factors responsible for the pressures on medical services. It will be no surprise to those of us who live in rural communities that the demographic changes over the past decades have contributed a great deal to these matters—our young people leaving, and older people moving into our rural areas in their stead.

This demographic shift means that, across the region, we have an ageing population, and this is reflected, and has been reflected, over the past decade. We've heard about this from Jane Dodds already. In counties such as Ceredigion and Powys, where we've seen an increase of 5 per cent in those over 65 years of age. What this demonstrates is that the Welsh Government needs to do a great deal more to try and keep our young people in rural Wales, and to attract those people who have already left back, if they so wish.

Photo of Cefin Campbell Cefin Campbell Plaid Cymru 6:07, 15 May 2024

As a result of this ageing population, we're now facing a very real and rapidly increasing conundrum. On the one hand, our rural communities' healthcare needs have arguably never been greater. However, as we've already heard this afternoon, those front-line GP services are increasingly at risk of moving further and further away from the rural communities they serve. Added to this, an ageing population means the complexity of individual patients' needs are often at unprecedented levels, and the traditional 10-minute appointments are now far from being suitable to either the GP or the patient in delivering a holistic health package. Couple this added complexity with a 32 per cent surge in the average numbers of patients per full-time GP over the past decade, and the picture and strain on our surgeries becomes even clearer.

Photo of Cefin Campbell Cefin Campbell Plaid Cymru 6:08, 15 May 2024

(Translated)

Of course, it isn't just our rural communities that are ageing. An increasing number of our GPs are also ageing and are retiring, and, as we have seen very recently in Laugharne and at present at St David's in Pembrokeshire, there is a real possibility that we could see a number of our communities being left without any GP provision at all at a time when our rural transport connections are shrinking very quickly, which makes it even more difficult for older people in particular to get to surgeries.

It's clear, Cabinet Secretary, that the current bonus system for junior doctors has failed to achieve its objective. So, I'd like to see the Government thinking more outside the box, and I'm happy to support the call by Jane Dodds for you to consider, perhaps, the issue of a rural bonus for GPs, and also think about how we can alleviate the pressures on our GPs. One way of doing exactly that would be more prescribing by local pharmacists. As it happens, I had an opportunity recently to visit a pharmacy in Llanidloes, Powys, that provided a prescription service, thereby taking a great deal of pressure off the local surgery, and it would be good to see such a model being rolled out as a matter of urgency across the whole of Wales. 

To conclude, therefore, as Mabon outlined earlier, we urgently need a system that ensures that working in Wales, and in rural Wales in particular, is attractive to those who are eager to serve our communities as GPs. 

Photo of David Rees David Rees Labour 6:10, 15 May 2024

(Translated)

I call on the Cabinet Secretary for Health and Social Care, Eluned Morgan. 

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:11, 15 May 2024

Diolch, Dirprwy Lywydd. I want to start by putting on record how much I value the work that GPs and their teams do every day to keep people in Wales safe and well. General practice is the cornerstone of the national health service, providing high-quality care close to our homes, often in the face of incredibly high demand. This is a vital and much-loved service. GPs and their teams of healthcare professionals are a trusted source of advice and care, and are the gateway to the rest of the healthcare service, rooted in all our local communities. The majority of healthcare is provided in primary care. The equivalent of almost half the population of Wales contacts their GP every single month, but we can all support general practice by looking after our own health by eating better, being physically active and maintaining social relationships and connections. We can also help support our local GPs by choosing the right service for our health needs, and that doesn't always mean calling the doctor for an appointment every time we feel unwell. Pharmacies now provide advice and free treatment for 27 common ailments, compared to seven that they can help with in England. This, as well as the introduction of the 111 service that deals with 70,000 calls a month, has helped to take pressure off GPs, because we want to make sure that GPs continue to be there for us when we need them, and we want them to do the work that they alone are trained for. But, just like the rest of the NHS, they and their services will continue to adapt to meet the changing needs of the profession of healthcare and the public.

Over recent years and in the face of record energy costs and persistently high inflation, the trend across the UK has been for GP partners to consolidate their services to reduce costs. GPs, of course, are independent providers—they're not employed directly by the NHS, although generally the NHS is their only contractor. Many are keen to build in additional resilience to their GP practices so they can employ pharmacists, allied health professionals, highly qualified nurse practitioners, who all help to take the pressure off them. And it's much easier to do this if you merge your practice with others, and this has led to a reduction in the overall practice numbers, but to more larger practices. My husband's own practice in Ely is an example of this. It merged with another practice, but it's providing exactly the same service from the same premises, but there's more resilience in the system. I hope the Chamber will—

Photo of Gareth Davies Gareth Davies Conservative 6:13, 15 May 2024

Will you take an intervention on that, Minister? Thank you very much. Why is there the disparity, then, between the general medical services contract for GP surgeries and the ones directly run by health boards in that case, because I and Darren Millar visited Madryn House Surgery in Rhyl a few months ago, and that was the evidence we heard from a GMS contractor? I see casework in my constituency where there are grave complaints about health board-run GP services, where it's not necessarily the case with GMS-run contract services.  

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:14, 15 May 2024

Well, they're employed by different people, so their contracts are necessarily going to be different. But I hope the Senedd will allow me to indulge just for a couple of seconds, just to note that my husband will be retiring from GP practice in 12 working days' time after 30 years of service in the community of Ely. So, I want to thank Rhys for his service to that community. [Applause.] I want to thank also all GPs across Wales. I want to put on record how much I value the work GPs do in their teams every day to keep us well.

The fact is that the number of GPs in Wales remains steady. The number of staff apart from GPs themselves working in GP practices is increasing significantly, but even for GPs, the target of 160 new GP trainees each year is consistently being exceeded. I think it's probably worth noting that there are more GP partners per head in Wales than there are in England. We're also seeing an increase in the number of GPs taking up salaried positions, either within independent GP services or directly employed by health boards. It seems that many younger GPs don't want to be partners and to take on the responsibility of running what is, effectively, a small and complex business that is wrapped up in complex regulation, which is there to protect the public.

We've consistently supported GPs, we've consistently worked with GPC Wales, and have taken steps to sustain and to strengthen general practice. And that's true also in rural areas. The fact is we do have a rural incentive to train GPs in rural areas, and we've just increased the amount we give them from £5,000 to £7,000. And on top of that, when there is a need to try and attract people to certain areas, the health boards put the additional money on the table. I can give you an example. In the Goodwick practice, which was about to close, they offered £20,000 extra to try and attract people there, and they still didn't come, so it's not always about money; they now want to be in a more resilient service. People don't want to be working on their own. That seems to be the pattern that we're seeing.

Last October, we introduced the unified contract that simplifies what services all GP practices must provide and reduces unnecessary bureaucracy, so more GP time can be freed up to care for patients. Now, for the first time, through the unified contract, we've been able to make our expectations about access to services a contractual requirement. This ensures consistency of approach across Wales, and it's this consistency that has helped us address the 8 a.m. bottleneck in Wales, which remains a significant issue still in England. The new contract also provides a foundation for future digital improvements through electronic prescriptions and the use of the NHS app. These will benefit and convenience both practices and the public. The new contract was developed in recognition that GPs are a part of a wider system of care. Because at the heart of our primary care model for Wales is the principle that people should be able to access care that meets their needs at the right time closest to home as possible.

Photo of Sam Rowlands Sam Rowlands Conservative 6:18, 15 May 2024

Thank you for taking an intervention. You're absolute right, people should be able to access the care that they need closest to home. But, clearly, with 99 surgeries having closed across Wales in the last 10 years, physically accessing those services has become more and more difficult for many people, especially in our rural communities. Would you acknowledge that?

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

What we've done is to put in place new urgent primary care centres, but I recognise, particularly in rural areas, that is a challenge for people who don't have access to vehicles. It's something I brought up recently with the new chair of Hywel Dda, just to try and recognise that, actually, people are challenged. Health boards have to make that a part of their consideration when they're planning for how services should be provided. The fact is there are lots of alternatives now in terms of where you can get support. You just think of pharmacies, where 600,000 consultations really took the pressure off GP services. Seventy thousand people take advantage every month of the 111 service.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:19, 15 May 2024

(Translated)

We've invested £5 million in allied professional healthcare workers and more than £8 million to ensure that there are more community nurses available on weekends, and this will ensure more support for GPs, through community resource teams, and will help people living with illness. Investing in primary care services is very valuable, and that is where most healthcare happens; it is central to the preventative agenda. Could we provide more funding for primary care? Yes, we could. But the fact is that, since 2005, we have increased the amount provided by £250 million.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:20, 15 May 2024

So, whilst you are right to say that the proportion that we spend on GP services has gone down, the amount has gone up significantly since 2005. And why is it that it's gone down? It's gone down because we've deliberately tried to respond to the pandemic and the long waiting lists. We said we're going to spend £1 billion on clearing the backlog. The backlog is in secondary care, not in primary care, and that's why that balance is not where we want to be. But we're clearing the backlog, and I hope you understand the reason, because in our strategy, 'A Healthier Wales', we're very clear that the direction we want to travel in is more support in our communities and in primary care.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour

(Translated)

Deputy Llywydd, in order achieve our—[Interruption.]

Photo of David Rees David Rees Labour

No, sorry, Russell. The Minister is already out of time, and I've given her some time for the interventions.

Photo of Baroness Mair Eluned Morgan Baroness Mair Eluned Morgan Labour 6:21, 15 May 2024

(Translated)

—'A Healthier Wales' ambitions, that's what we will do: rebalance. But we must bring waiting times down. To do this, we have to look at the whole system. But I would like to conclude just by thanking our doctors, particularly those working within our communities.

Photo of David Rees David Rees Labour

(Translated)

I call on Peter Fox to reply to the debate.

Photo of Peter Fox Peter Fox Conservative

Diolch, Dirprwy Lywydd. Can I thank all Members for their contributions today? There is no doubt about it, from listening to you all, that there is clearly something very wrong with our Welsh health service as it relates to GP practices when we see such a significant reduction in the number of GPs across Wales.

Can I thank Sam Rowlands for opening our debate? His contribution set out the concerns around our GP practices. Sam shared that number of 99 fewer GP practices now—that is really significant—and pointed out the reduction in funding levels and how years of underfunding has led to the situation that we're in. It's hitting people hard and citizens hard. He pointed out that we need that workforce strategy. Recruitment and retention is so fundamental; there's a crisis here in Wales. 

Mabon highlighted, as others did, the crisis in primary care and certainly rural Wales. We heard about those reduced numbers of GPs and the contracts that are being handed back. I think we've all seen that in our communities, with over 18 per cent, Mabon said, of surgeries being reduced. There is a clear need for wider NHS reform. 

Mike Hedges thanked the primary care services across Wales, recognising the vital part they play, but recognised that when it goes wrong it causes problems. But he also pointed out and reminded us about the other facets of primary care, which are so important, and how important the sustainability of GP practices is. 

Janet pointed out and reflected on the older persons' commissioner's report and how we can't afford to lose even one more GP practice. It was really concerning that elderly people are struggling to engage with GPs as they need to.

Heledd said that it's the hot topic wherever we are across Wales, and asked how we look at things like public transport, because it's preventing people from accessing their GPs. It's difficult for GPs at the moment, we know that, and they're under severe strain. I thank Heledd and the Plaid group, because I understand you will be supporting our motion tonight.

Jane Dodds shared the views, as others did, about the rural practitioners and the problems they have with an older demographic across such a wide area, and that was echoed by Sam Kurtz later on. The rural challenges are significant, and they're different in many ways to many other areas, especially where you can't even access a general hospital and you have to cross the border to get the things you need. It also helped us understand the pressures on the farming community and how poor housing stock can also have an important influence.

Mark Isherwood pointed out that GPs are a lifeline. He pointed out the cuts to NHS funding here over the years and said that the Government were told by the BMA many times over the years about the threat to the sustainability of GP practices. It's clear those concerns were known.

Rhianon played the usual card where she blamed the UK Government—total denial. I would suggest she visits her local GP and asks them what they feel about the current practice and the contracts they might be under.

Sam Kurtz, as I said, again, talked about rural areas, but he also wanted to, as we all do, thank those people who work—all practitioners and their teams—day in, day out for us. He recognised it's not their fault. He shared the example of Argyle Street and how they've had a reduction. And this is what I'm finding in my own constituency: GPs are employing different types of practitioner, but they really want to employ another GP, but the contracts won't allow them to do it, and that is the real issue.

Cefin pointed out, again, those challenges around rural GP practices and how the need for healthcare has never been greater in those areas, and the complexity of ageing populations, and that 32 per cent increase in patients per GP—how much more pressure that is putting on.

The Cabinet Secretary went on the record about the value of GPs and their teams. I know you believe that and we all recognise that they are the cornerstone, they are vitally loved services. And there is a lot of call. You said that a number equivalent to half of the population contact their GP every month. And that is why it is so important, that's why we've got this debate here, because we're hearing from hundreds of people—all of you must do. Even if you're not saying it in this Chamber, you must be hearing from your practices, sharing those concerns, because why is it only us who are hearing them? You must be hearing them.

Photo of Peter Fox Peter Fox Conservative

Yes, I certainly will.

Photo of Russell George Russell George Conservative

One of the concerns that I continue to receive is that bottleneck at 8 a.m. in the morning. Colleagues are agreeing with that. 

Photo of Russell George Russell George Conservative

I will. I'm intervening on this, because I think in the Minister’s response the Minister suggested that wasn't the case. The Minister is saying to me to write to her on that. I think we must all do that when we get that experience, because the Minister is obviously being told something different. So, I'm very keen that the Minister gets to know about these issues.

Photo of Peter Fox Peter Fox Conservative

Thank you for that intervention. Absolutely, I think we all experience that 8 a.m. blockage, and if you can't get an appointment, you've got to start again the following day.

Photo of Peter Fox Peter Fox Conservative

But they won't answer the phone. How do you complain? Or you're having to apply for an appointment over an app, which takes you over 10 minutes to fill out.

So, it's quite simple, Dirprwy Lywydd, we have to recognise the fundamental importance of a sustainable primary care service, and currently there is no way we could suggest our primary care, in its current form, is sustainable. In my own constituency, as I've pointed out, I've spoken to at least two practices recently. They're struggling to make ends meet. The contracts do not cover the valuable discretionary services GPs offer to our constituents, and I raised this recently in a short debate. That funding regime in our health service constantly favours secondary care. Indeed, less of our Welsh NHS funding, as we've heard, goes to general practice, and that is a backward step. This is leading them to cease providing these important services, moving forward.

This leads to huge pressures for the vulnerable people who then have to make huge trips or have huge waiting times to get the services they require. Clearly this short-sighted arrangement within the health system here is having a profoundly negative effect on many of the most vulnerable in society. It's really affecting their well-being and, ironically, putting additional pressure on hard-pressed secondary care. I urge Members to support our motion, as to not do so is turning your backs on the general practitioners and, through doing so, turning your backs on our citizens.

Photo of David Rees David Rees Labour 6:29, 15 May 2024

(Translated)

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] There are objections. I will therefore defer voting under this item until voting time.

(Translated)

Voting deferred until voting time.

Photo of David Rees David Rees Labour 6:29, 15 May 2024

(Translated)

That brings us to voting time. Unless three Members wish for the bell to be rung, I will move immediately to voting time.