English: This report was published in October, and I'm obviously keen to understand why we're only debating it now. I appreciate you have to wait for the Government's response, but as I'm not a member of the committee, it is important that we are all absorbing the evidence that you're gathering, because we are talking about half our whole budget, and therefore we all have a duty to ensure that the money we are allocating to health is being spent in the best possible way. I think primary care clusters are hugely important as a way of breaking down artificial barriers - artificial demarcation lines - between different professionals. It's also a way of tackling underperforming practices, or struggling practices, like the case that Julie Morgan's just described where the practice went out of business and nobody was prepared to take it on. Had they known about it earlier, had the cluster arrangements been closer, perhaps another practice would have been ready to take it on, particularly if they weren't presented with a surprise. Today, I've had an excellent experience with a practice manager. I needed to very quickly establish whether a particular form that's called DS1500 had been provided to the DWP to enable somebody to get the attendance allowance that people are entitled to at the end of their life. So, this is an urgent matter. I have nothing but praise for the practice manager. This is a practice manager task. It's nothing to do with a GP in the sense that I'm not seeking clinical advice; I'm seeking administrative advice. I need to know whether this form has been sent. When we managed to establish that the DWP had lost the form, she immediately agreed to send it again and to ensure that it got there in time. So, I would just like to say that any GP who is not delegating the day-to-day administrative management of their practice to a practice manager is not using their clinical skills effectively. They should not be needing to worry about whether or not the equipment that people need to examine patients is available. That is something that somebody else should be doing. Equally, I do find it very frustrating when I visit pharmacists to learn that GP practices are resistant to sharing the information about what medication patients are receiving. This should be available through the IT system, to enable the pharmacist, who is the specialist in medicines, to be seeing exactly what cocktail of drugs this patient is getting and whether or not what's been written on the prescription is appropriate to that individual. I'm afraid it's not uncommon, with prescriptions, for the point to be in the wrong place, and that can be extremely worrying. Of course, pharmacists are the front line. Everybody knows stories of the difficulties of getting an appointment with the GP, whereas with the pharmacist, you can walk in and you will get the advice immediately. So, I think that clusters need to be working much more closely with pharmacists, as well as other professionals, who will enable us to share the workload more effectively in line with prudent healthcare. I read, with some puzzlement, that pharmacists weren't always invited. It's not that everybody needs to be at the cluster meeting on every single occasion. It all depends on what is the subject that's going to be discussed at a particular meeting. Should the health boards be more or less involved? Well, we always have to follow the money because if health boards aren't prepared to ensure that the money is being passed down from secondary to primary care, we are never going to get the change that we need to ensure that we have a sustainable health service. I'd just like to finish by reminding people that I mentioned in the Assembly previously the case study of Canterbury, New Zealand, which has spent several years getting more integrated care between primary, secondary and community care, and that that has prevented the ballooning of demands on hospital care, which we all need to see. We don't need reminding as to what's going on out in the world today. So, we need to learn quickly and we need to get on with this rather than delaying further. This has to be one way forward.
Welsh: Cyhoeddwyd yr adroddiad hwn ym mis Hydref, ac rwy'n amlwg yn awyddus i ddeall pam nad ydym wedi ei drafod hyd yma. Rwy'n deall bod yn rhaid i chi aros am ymateb y Llywodraeth, ond gan nad wyf yn aelod o'r pwyllgor, mae'n bwysig fod pawb ohonom yn amsugno'r dystiolaeth rydych yn ei chasglu, oherwydd rydym yn sôn am oddeutu hanner ein cyllideb gyfan, ac felly mae gan bawb ohonom ddyletswydd i sicrhau bod yr arian rydym yn ei ddyrannu i iechyd yn cael ei wario yn y ffordd orau sy'n bosibl. Credaf fod clystyrau gofal sylfaenol yn hynod o bwysig fel ffordd o chwalu rhwystrau artiffisial - ffiniau artiffisial - rhwng gwahanol weithwyr proffesiynol. Mae hefyd yn ffordd o fynd i'r afael â phractisau sy'n tangyflawni, neu bractisau mewn trafferthion, fel yr achos a ddisgrifiodd Julie Morgan yn awr lle roedd y practis yn rhoi'r gorau i weithredu ac nid oedd neb yn barod i'w gymryd. Pe baent yn gwybod amdano yn gynharach, pe bai'r trefniadau clwstwr wedi bod yn nes, efallai y byddai practis arall wedi bod yn barod i'w gymryd, yn enwedig pe na baent wedi gorfod wynebu sefyllfa annisgwyl. Heddiw, cefais brofiad ardderchog gyda rheolwr practis. Roedd angen i mi sefydlu'n gyflym iawn a ddarparwyd ffurflen arbennig o'r enw DS1500 i'r adran gwaith a phensiynau i alluogi rhywun i gael y lwfans presenoldeb y mae gan bobl hawl iddo ar ddiwedd eu hoes. Felly, mae hwn yn fater brys. Nid oes gennyf ddim ond canmoliaeth i'r rheolwr practis. Tasg i reolwr practis yw hon. Nid yw'n ddim i wneud â meddyg teulu yn yr ystyr nad wyf yn gofyn am gyngor clinigol; rwy'n gofyn am gyngor gweinyddol. Mae angen i mi wybod a yw'r ffurflen hon wedi ei hanfon. Pan lwyddasom i sefydlu bod yr adran gwaith a phensiynau wedi colli'r ffurflen, cytunodd ar unwaith i'w hanfon eto a sicrhau ei bod yn cyrraedd yno mewn pryd. Felly, hoffwn ddweud nad yw unrhyw feddyg teulu nad yw'n dirprwyo'r gwaith gweinyddol o ddydd i ddydd o reoli eu practis i reolwr practis yn defnyddio ei sgiliau clinigol yn effeithiol. Ni ddylai fod angen iddynt boeni a yw'r offer y mae pobl ei angen i archwilio cleifion ar gael ai peidio. Mae hynny'n rhywbeth y dylai rhywun arall fod yn ei wneud. Yn yr un modd, rwy'n ei chael hi'n rhwystredig iawn pan ymwelaf â fferyllwyr i glywed bod meddygfeydd yn gwrthod rhannu gwybodaeth ynglŷn â pha feddyginiaeth y mae cleifion yn ei chael. Dylai fod ar gael drwy'r system TG, er mwyn galluogi'r fferyllydd sy'n arbenigo mewn meddyginiaethau, i weld yn union pa goctel o gyffuriau y mae'r claf hwn yn ei gael ac a yw'r hyn a ysgrifennwyd ar y presgripsiwn yn briodol i'r unigolyn dan sylw. Yn anffodus, nid yw'n anghyffredin, gyda phresgripsiynau, i'r pwynt fod yn y lle anghywir, a gall hynny fod yn destun pryder mawr. Wrth gwrs, fferyllwyr yw'r rheng flaen. Mae pawb wedi clywed storïau am anawsterau i gael apwyntiad i weld meddyg teulu, ond gyda'r fferyllydd, gallwch gerdded i mewn ac fe gewch y cyngor ar unwaith. Felly, rwy'n credu bod angen i glystyrau fod yn gweithio'n llawer agosach gyda fferyllwyr, yn ogystal â gweithwyr proffesiynol eraill, a fydd yn ein galluogi i rannu'r llwyth gwaith yn fwy effeithiol yn unol â gofal iechyd darbodus. Darllenais, gyda pheth dryswch, nad yw fferyllwyr bob amser yn cael gwahoddiad. Nid bod angen i bawb fod yn y cyfarfod clwstwr ar bob achlysur. Mae'n dibynnu beth yw'r pwnc sy'n mynd i gael ei drafod mewn cyfarfod penodol. A ddylai byrddau iechyd gymryd mwy o ran neu lai o ran? Wel, rydym bob amser yn gorfod dilyn yr arian oherwydd os nad yw byrddau iechyd yn barod i sicrhau bod yr arian yn cael ei drosglwyddo i lawr o ofal eilaidd i ofal sylfaenol, nid ydym byth yn mynd i gael y newid sydd ei angen arnom i sicrhau bod gennym wasanaeth iechyd cynaliadwy. Hoffwn orffen drwy atgoffa pobl fy mod wedi sôn yn y Cynulliad o'r blaen am astudiaeth achos Canterbury, Seland Newydd, sydd wedi treulio nifer o flynyddoedd yn cael gofal mwy integredig rhwng gofal sylfaenol, gofal eilaidd a gofal cymunedol, a bod hynny wedi rhwystro galwadau am ofal ysbyty rhag cynyddu i'r entrychion, ac mae angen i bawb ohonom weld hynny. Nid oes angen ein hatgoffa beth sy'n digwydd yn y byd heddiw. Felly, mae angen inni ddysgu'n gyflym ac mae angen inni fwrw ymlaen â hyn yn hytrach nag oedi ymhellach. Rhaid i hon fod yn un ffordd ymlaen.