Written Statement - Developing the primary care workforce in Wales

This statement updates Assembly Members about progress with the development of the primary care workforce plan for Wales, which supports the recently published plan for a primary care service for Wales. It also sets out the principles underpinning the development of the workforce plan and its aims.

Everyone in Wales should be supported to improve their health and wellbeing and, when they become ill, they should be diagnosed, treated and cared for by the right healthcare professional, in a timely manner, as close to their homes as possible.  We want more health services to be available in local communities, reducing the need for people to travel to or be admitted to hospital when they need treatment.

The GP remains at the heart of primary care in Wales; however, people will increasingly receive advice and care from a wider range of highly-skilled health professionals working in primary care. These professionals – practice nurses, advanced practitioners, pharmacists and physiotherapists for example – working with GPs, need to be able to respond to the challenges of an increasing demand for healthcare; an increase in people being diagnosed with one or more long-term conditions and an increase in frail and older people with more complex care needs.

The number of people working in or funded by NHS Wales is now greater than at any time since the National Assembly was established. We also know that the majority of the professionals who will be working in the NHS in 10 year’s time are already working in the health service today.  

This means that although there will always be a need to recruit staff directly into the NHS, we must also ensure the existing workforce has the opportunity to extend their skills and experience.

The Welsh Government and health boards invest heavily in education and training every year; we must target this to support the workforce of today to take up new or extended roles and opportunities for advanced practice, which will be key to realising the skilled workforce of the future.  

As we redesign the workforce in Wales, we must be guided by the principles of prudent healthcare. No GP should routinely be undertaking any activity which could just as appropriately be undertaken by an advanced practice nurse, a clinical pharmacist or an advanced practitioner paramedic. Equally, no advance practice nurse should routinely be undertaking work which could be done by a healthcare support worker.

This unifying principle of ‘only do what only you can do’ is central to improving care, and access to that care.  It is also the way in which we can improve the workload and job satisfaction over the longer term for all those who work in general practice and primary care.

To achieve this vision there will be a need for the Welsh Government and local health boards to work in partnership with staff, the public, the contracted workforce and the third sector to:

• Establish clear plans, at a local health board level and increasingly at cluster level, for the movement of services from acute and hospital settings to the community and, in so doing; develop a better shared understanding of the work that will be done in primary care in the future and the necessary shape, size and skills of the future workforce. 
• Equip the workforce to assess and respond to population health needs.  Local health boards are already responsible, through the NHS Wales Act 2006, for planning and delivering services on a population basis.  The Social Services and Well-being (Wales) Act 2014 reinforces those duties through the need for population assessment to be undertaken in partnership with local authorities, together with a duty to provide information, advice and assistance.
• Change the employed and contracted workforce culture, expectations, and ways of working to create the best possible conditions to secure the workforce of the future.  This will need to include greater flexibility of working between community and hospital settings to benefit those who receive care and aid the continuing professional development of the workforce.
• Change the nature of the primary care 'relationship' including through the levers of the GP and other contract mechanisms, and where appropriate through directly employed models. This will include growing multi-disciplinary teams and developing the leadership capacity and capability of the 64 primary care clusters.
• Shift the focus of our medical education and training programme so that its current strong bias towards the acute sector is ended, and to grow the range of non-medical education and training programmes for a wider range of roles.

The primary care workforce plan will put in place the foundations for a more robust approach to workforce planning and education commissioning, support the continuing development of primary care clusters and the sharing of good practice and invest in the rapid development and integration of the wider primary care workforce.

It will respond to existing pressures in primary care as a result of changing demands, ensuring services are sustainable. In this respect I have recently responded to the Health and Social Care Committee’s recommendations from their short inquiry into the GP workforce in Wales.

The plan will also take into account the recommendations of the review of healthcare professional education in Wales, led by Mel Evans, which was commissioned last year to examine whether Wales gets value for money from the current arrangements, and is due to be published shortly.

A national clinical lead for primary care will be appointed to take forward both the national primary care plan for Wales and the workforce plan. This is an important leadership role and will help to achieve our aim of transforming the way services are provided in Wales and making primary care the engine room of the NHS.

Many of the changes set out in both the national primary care plan and the workforce plan will take time to deliver. However, this is an opportunity for fundamental change which we cannot afford to miss.

I would like to place on record my thanks to the many thousands of people who make up our primary care workforce, from receptionists to specialists.  They are the important bedrock on which the public depend to provide the many health services we all take for granted.