Eitem 4 yw'r datganiad gan y Gweinidog Iechyd a Gwasanaethau Cymdeithasol: mynediad at wasanaethau gofal sylfaenol. A galwaf ar y Gweinidog, 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.

Ym maes optometreg, rydym ni eisoes yn ehangu'r ddarpariaeth â ffocws clinigol mewn gofal sylfaenol. Mae hynny'n cael ei wneud drwy symud rhai gwasanaethau gofal llygad o'r ysbyty i'r gymuned, lle mae gweithlu medrus ar gael i ateb y galw cynyddol. Cyn bod rhai elfennau o'r diwygio yn gallu dod i rym, bydd angen gwneud newidiadau i'r rheoliadau, ac, wrth gwrs, fe fyddwn ni yn ymgynghori ar y cynigion. Yn y cyfamser, mae'r broses ar y gweill i gyflwyno gwasanaethau gan optometryddion â chymwysterau uwch, fel rhagnodi annibynnol, glawcoma a retina meddygol, gan ddefnyddio'r cyfarwyddiadau deddfwriaethol presennol. Rŷn ni'n sylweddoli mai'r llwybrau gwasanaeth hyn fydd yn cael yr effaith fwyaf o ran cefnogi gwasanaethau gofal llygad arbenigol mewn ysbytai.

Rydym ni hefyd yn gwneud cynnydd da wrth alluogi cleifion i gael mynediad uniongyrchol at lwybrau awdioleg heb gael eu cyfeirio gan feddyg teulu neu weithiwr proffesiynol arall yn y maes iechyd neu ofal cymdeithasol. I hwyluso'r newid yma, rydyn ni'n ymwneud mwy â'r trydydd sector a'r cynghorau iechyd cymuned, gan greu capasiti mewn gwasanaethau awdioleg drwy gamau cadarn i gynllunio'r gweithlu.

Mae mynediad at weithwyr proffesiynol perthynol i iechyd mewn gofal sylfaenol yn flaenoriaeth hefyd, ac mae hyn yn dal i gael ei symud ymlaen drwy'r rhaglen strategol gofal sylfaenol. Ym mis Ionawr, gwnes i gyhoeddi £5 miliwn yn ychwanegol i gynyddu nifer y gweithwyr proffesiynol hyn ac i wella mynediad at wasanaethau adsefydlu yn y gymuned i helpu pobl i ddal i fod yn actif ac yn annibynnol.

Bydd yr ymrwymiad yn y rhaglen lywodraethu i fuddsoddi mewn cenhedlaeth newydd o hybiau iechyd a gofal cymdeithasol integredig yn bwysig wrth helpu i greu capasiti cymunedol. Drwy ein cronfa buddsoddi cyfalaf newydd, rŷn ni'n dechrau gweld cynigion yn dwyn ffrwyth, gan gynnwys hyb lles Rhiwbeina, sydd newydd gael ei gwblhau. Mae hwn yn galluogi pobl i gael gafael ar amrywiaeth fwy eang o wasanaethau iechyd, gofal a lles yn nes at adref.

Mae buddsoddiad pellach wedi ei wneud mewn nyrsio cymunedol, sef ychydig o dan £3 miliwn ers 2021. Mae hwn er mwyn datblygu ar yr hyn a gafodd ei ddysgu drwy'r cynlluniau peilot nyrsio yn y gymdogaeth. I gefnogi hyn mae'r system amserlenni electronig yn galluogi timau nyrsio ardal i wneud yn siwr bod eu gwasanaeth i gleifion yn cael ei ddarparu gan y nyrs gywir â'r sgiliau cywir bob tro.

Ar draws yr holl wasanaethau hyn mae sicrhau tegwch mynediad yn hanfodol. Mae'r Llywodraeth yma yn cydnabod yr angen i roi pwyslais penodol ar sicrhau bod grwpiau bregus yn gallu cael gafael ar wasanaethau, gan gynnwys pobl sydd yn cael eu hystyried yn fregus.

Yn ddiweddar, rydym wedi comisiynu ymchwil annibynnol i gael safbwyntiau'r cyhoedd yng Nghymru ynglŷn â mynediad at wasanaethau gofal sylfaenol a beth mae mynediad da yn ei olygu iddyn nhw. Mae barn y cyhoedd yn hynod o bwysig wrth inni weithio i ddatblygu polisi sy'n cefnogi eu hanghenion gofal sylfaenol.

Yn olaf, dwi eisiau cydnabod fy niolch i i'r gweithwyr proffesiynol sy'n gweithio mewn gofal sylfaenol. Heb eu hymroddiad a'u hyblygrwydd nhw, fyddai dim modd darparu'r gwasanaethau dwi wedi cyfeirio atyn nhw a thrawsnewid y gwasanaethau hynny er lles pobl Cymru. Diolch.

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.

Gaf i ddiolch i'r Gweinidog am y datganiad yna? O bosib y peth mwyaf arwyddocaol ydy'r ffaith bod darn o waith ymchwil wedi cael ei gomisiynu gan y Gweinidog yn ddiweddar er mwyn trio dod i ddeall yn well beth ydy profiadau pobl o gael mynediad at wasanaethau gofal sylfaenol, a beth mae mynediad da yn ei olygu iddyn nhw. Mae'n wirioneddol yn bwysig, dwi'n meddwl, ein bod ni'n deall hyn, achos mor aml mae profiad claf fel mae'n cael ei adrodd i fi ac i lawer ohonom ni, dwi'n siŵr, fel Aelodau o'r Senedd yma, yn wahanol iawn i'r hyn sy'n cael ei ddweud wrthym ni yn swyddogol.

Er enghraifft, mi wnaiff etholwyr i fi ofyn yn aml, 'Pam nad ydy meddygon teulu yn gweld pobl wyneb yn wyneb?' Wel, wrth gwrs, mae meddygon teulu yn gweld pobl wyneb yn wyneb, ac yn wir mi wnaeth meddygon teulu barhau i weld pobl wyneb yn wyneb drwy gyfnod COVID. Ond mae yna'r canfyddiad yma ei bod hi'n anoddach i gael mynediad at apwyntiad wyneb yn wyneb erbyn hyn. Felly mi hoffwn i glywed gan y Gweinidog am y gwaith sy'n cael ei wneud er mwyn rhoi eglurder i bobl am y math o wasanaethau y gallan nhw eu disgwyl wyneb yn wyneb gan eu meddygfa, fel eu bod nhw'n gallu cael syniad realistig o beth yn union ydy'r safonau mae'r Llywodraeth yn eu disgwyl ar hyn o bryd.

Dwi'n cyd-fynd yn llwyr efo'r hyn mae'r Llywodraeth yn trio ei wneud o ran siarad am ofal sylfaenol yn ei ddiffiniad mwyaf eang. Mae pobl yn dal i drafod 'mynd i weld y doctor', ond go iawn mynd i gael gwasanaeth iechyd mae angen i bobl ei wneud, a dyna pam ei bod hi mor bwysig bod pobl yn deall am y gwasanaethau sydd ar gael drwy fferyllfeydd ac yn y blaen. Mi fyddwn i'n hoffi clywed gan y Gweinidog am y math o fuddsoddiad mae'r Llywodraeth yn ei wneud neu'n ystyried ei wneud er mwyn mynd i'r afael â’r her addysgu yna sydd yn amlwg angen ei gwneud, oherwydd dim ond os ydy pobl yn deall y gwahanol ffyrdd y gallan nhw gael mynediad at wasanaethau iechyd y byddan nhw yn dechrau mynd i drio cael mynediad at wasanaethau mewn ffyrdd gwahanol a ffyrdd mwy cynaliadwy.

Un pryder arall sydd gen i, wrth droi at yr elfen ddeintyddol yn natganiad y Gweinidog, ydy bod y Llywodraeth, tra yn cyfaddef bod yna heriau, yn trio rhoi yr argraff bod gwasanaethau, ar y cyfan, yn dda mewn deintyddiaeth ar hyn o bryd. Dydw i ddim yn teimlo, o siarad efo deintyddion a llawer o gleifion deintyddol chwaith, bod hynny yn adlewyrchiad realistig. Dwi yn wirioneddol gredu bod yna argyfwng mewn deintyddiaeth yng Nghymru ar hyn o bryd. Rydym ni wedi gallu cyffwrdd ar hynny yma yn Siambr y Senedd droeon dros yr wythnosau ac yn wir y blynyddoedd diwethaf. Dwi yn gofyn am dôn wahanol gan y Llywodraeth wrth drafod deintyddiaeth. Roedd y Prif Weinidog, unwaith eto, yn y cwestiynau i'r Prif Weinidog heddiw, yn pwysleisio’r miliwn o bobl sydd wedi cael mynediad at ofal deintyddol dros y flwyddyn ddiwethaf. Wrth gwrs bod yna ystadegau positif mae modd cyfeirio atyn nhw o hyd, ond oni bai ein bod ni'n sylweddoli ein bod ni mewn cyfnod o argyfwng, dwi'n ofni na fydd y brys yna yn ymateb y Llywodraeth i'r argyfwng.

Ac yn olaf, yn dilyn y cyfeiriad gan y Gweinidog at y cynghorau iechyd cymuned yn ei hateb i lefarydd y Ceidwadwyr, mae gen i un cwestiwn penodol ynglŷn â Chyngor Iechyd Cymuned Gogledd Cymru. Rydym ni'n gwybod ein bod ni mewn cyfnod heriol tu hwnt o ran darpariaeth iechyd a gofal ar draws y gogledd, a bwrdd iechyd Betsi Cadwaladr wedi cael ei roi yn ôl mewn mesurau arbennig. Mi fyddwn i yn dadlau ei bod hi’n fwy pwysig nag erioed bod gennym ni gyngor iechyd cymuned sydd wirioneddol yn deall y gymuned honno ac yn gallu ymateb yn gyflym, er enghraifft yn gwneud ymweliadau dirybudd ac ati. Felly, onid oes yna ddadl gref dros alluogi cyngor iechyd cymuned y gogledd i barhau am y tro tra’n bod ni yn dal yn wynebu'r heriau yma efo Betsi Cadwaladr?

Diolch yn fawr. Dwi'n meddwl ei bod hi'n bwysig i ni ystyried beth mae access yn ei olygu i bobl, beth yw eu profiad uniongyrchol nhw, felly diolch am gydnabod bod y gwaith ymchwil yna yn mynd ymlaen. Dwi'n meddwl bod rhaid inni efallai helpu pobl i ddeall bod beth sydd wedi digwydd yn hanesyddol o ran cael access at GP ddim o reidrwydd y ffordd bydd pethau’n gweithio yn y dyfodol, yn rhannol achos dyw hi ddim yn ddefnydd da o’n GPs ni. Dyna pam mae'n rhaid inni eu harallgyfeirio nhw at bobl sydd, efallai, yn mynd i'w trin nhw gyda mwy o arbenigedd mewn un maes sydd yn fwy priodol iddyn nhw. Mae hynny yn newid, a dwi'n deall bod e’n newid sydd yn anodd i rai pobl, ond dwi yn meddwl mai dyna’r newid sydd angen inni ei weld.

Beth rŷn ni'n gobeithio ei weld yw mwy o gydlynu ar lefel clwstwr, felly bydd y GPs ac ati yn gweithio gydag allied health professionals ac eraill sy'n gweithio yn y maes, gyda fferyllfeydd, a bydd y rheini i gyd yn dechrau cydweithio lot yn well nag y maen nhw wedi yn y gorffennol. Mae hynny yn gweithio’n dda mewn rhai llefydd, ond yn amlwg mae'n rhaid inni fynd ymhellach.

O ran access, dwi'n meddwl ei bod hi'n ddiddorol, achos yn aml iawn rŷn ni'n clywed lot o sŵn am bobl sydd ddim yn cael triniaeth dda, ond mae lot o bobl yn dod lan ataf i a dweud cymaint maen nhw'n hoffi, er enghraifft, yr e-consult model sydd yn gweithio i lot o bobl, yn arbennig pobl, efallai, sydd yn gweithio. Does dim amser gyda nhw i fynd i weld GP ac maen nhw'n hoffi cael yr access yna. Felly, mae pethau’n gweithio’n well i rai pobl nag eraill, a dwi'n meddwl bod rhaid inni gydnabod hynny.

Rŷn ni wedi gwario miliynau ar dreial cael pobl i ddeall bod yna ffyrdd eraill i gael access at gael triniaeth. Dyna pam mae'r 'Help Us to Help You' campaign i'w weld ym mhobman. Mae hi wedi bod yn weladwy. Mae'n anodd i fynd i ffwrdd ohoni. Dwi'n meddwl bod hwnna'n rhywbeth sydd wedi gweithio. Mae hwnna'n rhoi gwybod i bobl bod pharmacies ar gael, bod 111 ar gael, bod urgent primary care centres ar gael, bod lot o lefydd eraill rŷch chi'n gallu mynd iddyn nhw heblaw am y GP. Dwi'n meddwl bod hynny wedi dechrau gweithio, ond mae'n rhaid i ni jest atgoffa pobl. Unwaith bydd pobl yn deall e am y tro cyntaf, byddan nhw wedyn, gobeithio, yn dilyn hynny yn y dyfodol.

O ran dentistry, dwi'n cydnabod bod yna le i wella, ond dwi jest yn meddwl bod pethau yn gwella. So, mae yna ffordd bell i fynd, ond rŷn ni ar y trywydd, a dwi'n meddwl bod hynny'n bwysig. Ond, beth sy'n glir yw gallwn ni ddim jest troi hwn ymlaen dros nos; mae'r bobl yma'n cymryd amser i ni hyfforddi. Dyna pam dwi'n meddwl bod e'n anodd, yn arbennig pan rŷn ni'n trio newid y system. Felly, beth rŷn ni eisiau gwneud yw defnyddio mwy o'r bobl yma, y dental therapists ac ati. Dyna pam rŷn ni'n agor mwy o ganolfannau mewn llefydd fel yn y gogledd.

Jest o ran y community health councils a'r grŵp newydd, Llais, dwi yn meddwl bod e'n bwysig bod llais y bobl sy'n defnyddio'r NHS yn cael ei glywed yn glir. Mae yna lot o baratoi wedi cael ei wneud o ran symud o'r community health councils i Llais. Felly, mae yna lot o baratoi wedi'i wneud. Bydd y rhan fwyaf o'r bobl a oedd yn gweithio i'r community health councils yn cael eu TUPE-io drosodd, felly yr un bobl ydyn nhw, ond mae'r system yn mynd i fod ychydig yn wahanol. Felly, dwi'n cydnabod a dwi'n meddwl ei bod hi'n bwysig bod pobl yn gwybod bod y system yn mynd i newid ac fe fydd yna ymgyrch i sicrhau bod pobl yn deall bod system newydd mewn lle.

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.

Ac yn olaf, 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.

Diolch i'r Gweinidog.