English: Some of it is, and as you listen to the rest of the debate, I think you may be slightly cheered. Granted, the headcount for GPs remains fairly stable. However, there is little recognition that many of those heads are not full time. Not only has the GP's role changed, but the way patients wish to access their GP has also changed. Patients still wish to see a named GP, and to be able to see him or her within a short space of time. To quote one doctor, who encapsulates neatly the views of many: 'Patients want immediacy, but immediacy with the doctor of their choice at the time of their choice, and that is a gold standard. We'd all like that, but there seems to be little understanding among patients that that isn't actually possible.' There is also a recognition that recent years have seen a decrease in self-care, with patients no longer seeing the GP as the final call when they are showing signs of illness, but the first. Figures also show that, although appointment times have been increasing, the UK still has one of the shortest appointment times, and a total of 73 per cent of all UK GPs said they were dissatisfied with the time they were able to spend with each patient. A recent Welsh BMA survey, in February this year, clearly demonstrates that: 57 per cent of GP practices reported the quality of service had dropped in the last 12 months; and, 64 per cent said their workload was either unmanageable a lot of the time or all of the time. Many of these issues could be tackled with better workforce planning, greater education and signposting. We really need to understand the picture we have before us. Cabinet Secretary, will you undertake to review the collation and sharing of data within the primary care sector, so that we can form a clear picture and share that knowledge base with all decision makers? I have noted that in your document, 'A Planned Primary Care Workforce for Wales', there is a desire to encourage primary care clusters to assess local need and match resources. However, comprehensive workforce planning needs to take into account the availability and training requirements for all the other primary care workforce, such as physiotherapists, nurses, optometrists, pharmacists, occupational therapists, speech and language therapists, healthcare support workers and clinical psychologists. We already know from committee inquiries, such as those into looked-after children, adoption, and child and adolescent mental health services, that we are facing a Wales-wide shortfall in speech and language therapists, eating disorder clinics, behavioural and social care support workers, and that timely access to mental health services is very difficult to receive. Today's GP is less a general doctor and more a complex care practitioner. She or he is being asked to front-line an extraordinarily diverse range of illnesses. They are being encouraged to manage as much as they can in order to take the pressure off the secondary care sector. However, in order to achieve that objective, they must be secure in the knowledge that there are a plethora of trained professionals that they can refer to. Unfortunately, there are not, which is why, Cabinet Secretary, I would ask that workforce planning is comprehensively undertaken throughout all areas of the primary sector, and that it looks at hours rather than heads, and future needs and training requirements rather than the status quo. Training and encouraging people into primary care is absolutely key to strengthening and planning for workforce management in front-line services. The BMA has highlighted that, despite commitments from successive Labour-led Welsh Governments, the overall training places for GPs in Wales remain static. They also state that investment not only needs to be made into high-quality undergraduate and postgraduate training in Wales, but also continuing professional development. We need to look for a national medical workforce. We need to have a compulsion for junior doctors training in Wales to undertake GP rotation as part of their training. I've had this message reinforced to me by local GPs who also raise concerns over whether the medical schools really grasp the importance of rotations as a means of ensuring that general practice is not perceived as the cinderella division of the medical profession. Add to this the view that trainees don't see becoming a GP as a desirable career due to increased costs surrounding indemnities, the ageing state of the buildings, you know, increased work pressures - people are just not wanting to enter into a very necessary and valuable part of the NHS workforce. Finally, I'd like to quickly turn to the Plaid amendment, which we will be abstaining on. Now, I totally accept that there's empirical evidence that clearly suggests that medical students often stay in the area where they are trained, and I recognise that this amendment mirrors the call by the Royal College of Physicians. However, such is the shortage of doctors, I would suggest that if a Scot, an Italian or a Welsh-domiciled person were to train in our medical schools, then we should embrace them with open arms and seek to retain them in the country where they have trained. I would also like to understand better how many Welsh-domiciled students are refused training or choose to train away because they cannot get the place locally. Hence an abstention, because I can be persuaded if you can show us the evidence. I think that a stronger argument, which my colleague will develop, is that we should increase the number of training places available and broaden the geographical research. Cabinet Secretary, this is a crisis that is enveloping general practice. So, in summation, we would like to see a recruitment programme that encapsulates the needs of partners and families, comprehensive workforce planning undertaken that includes all the strata of primary health care in order to ensure that general practice has the ability to refer patients across the piece in a timely manner, that there are changes made to the training of junior doctors in order to ensure that rotations into general practice are as routine and valued as rotations into cardiology or acute medicine, that a review is undertaken into the financial pressures in general practice from capital expenditure to indemnity insurance, that a comprehensive package is worked out with health boards and the ambulance trust to better understand the causes of the high levels of stress-related illnesses the services experience and that an accessible programme of intervention for individuals to access is put in place, and that the voice of general practice is strengthened and put front and centre in health board and Government planning. If you achieve this, Cabinet Secretary, you will avert the storm building in front-line services, and we, the Welsh Conservatives, will support you in this endeavour. Thank you.
Welsh: Peth ohono, mae'n wir, ac wrth i chi wrando ar weddill y ddadl, rwy'n meddwl efallai y cewch eich calonogi rywfaint. Rwy'n derbyn bod nifer y meddygon teulu yn parhau i fod yn weddol sefydlog. Fodd bynnag, nid oes llawer o gydnabyddiaeth i'r ffaith nad yw llawer ohonynt yn gweithio amser llawn. Nid yn unig mae rôl y meddyg teulu wedi newid, ond mae'r ffordd y mae cleifion yn dymuno cael mynediad at eu meddyg teulu wedi newid hefyd. Mae cleifion yn dal yn awyddus i weld meddyg teulu penodol, a gallu eu gweld o fewn cyfnod byr o amser. I ddyfynnu un meddyg, sy'n crynhoi barn llawer o bobl yn daclus: 'Mae cleifion eisiau ymateb ar unwaith, ond ymateb ar unwaith gan feddyg o'u dewis ar adeg o'u dewis, a dyna yw'r safon aur. Byddem oll yn hoffi hynny, ond nid yw'n ymddangos bod llawer o ddealltwriaeth ymhlith cleifion nad yw hynny'n bosibl mewn gwirionedd.' Mae yna gydnabyddiaeth hefyd fod lefelau hunanofal wedi gostwng yn y blynyddoedd diwethaf, ac nid yw cleifion bellach yn ystyried y meddyg teulu fel cam olaf pan fyddant yn dangos arwyddion o salwch, ond y cam cyntaf. Hefyd, er bod amseroedd apwyntiadau wedi bod yn cynyddu, dengys ffigurau mai'r DU sydd ag un o'r amseroedd apwyntiad byrraf, a dywedodd cyfanswm o 73 y cant o'r holl feddygon teulu yn y DU eu bod yn anfodlon gyda'r amser y gallent ei dreulio gyda phob claf. Mae arolwg BMA Cymru yn ddiweddar, ym mis Chwefror eleni, yn dangos yn glir bod 57 y cant o bractisau meddygon teulu wedi adrodd bod ansawdd y gwasanaeth wedi gostwng yn ystod y 12 mis diwethaf; a dywedodd 64 y cant nad oeddent yn gallu ymdopi â'u llwyth gwaith naill ai lawer o'r amser neu drwy'r amser. Gellid ymdrin â llawer o'r materion hyn drwy gynllunio'r gweithlu'n well, drwy fwy o addysg a chyfeirio. Mae gwir angen i ni ddeall y darlun sydd gennym. Ysgrifennydd y Cabinet, a wnewch chi ymrwymo i adolygu'r broses o gasglu a rhannu data o fewn y sector gofal sylfaenol, er mwyn i ni ffurfio darlun clir a rhannu'r sylfaen wybodaeth â'r rhai sy'n gwneud penderfyniadau? Nodais yn eich dogfen, 'Gweithlu Gofal Sylfaenol wedi'i Gynllunio i Gymru' fod yna ddymuniad i annog clystyrau gofal sylfaenol i asesu angen lleol a chael adnoddau i gyd-fynd â hynny. Fodd bynnag, mae angen i gynlluniau cynhwysfawr ar gyfer y gweithlu ystyried argaeledd ac anghenion hyfforddi ar gyfer gweddill y gweithlu gofal sylfaenol, megis ffisiotherapyddion, nyrsys, optometryddion, fferyllwyr, therapyddion galwedigaethol, therapyddion lleferydd ac iaith, gweithwyr cymorth gofal iechyd a seicolegwyr clinigol. Rydym eisoes yn gwybod o ymchwiliadau pwyllgorau, fel y rhai ar blant sy'n derbyn gofal, mabwysiadu a gwasanaethau iechyd meddwl plant a'r glasoed, ein bod yn wynebu prinder drwy Gymru gyfan o therapyddion lleferydd ac iaith, clinigau anhwylder bwyta, gweithwyr cymorth ymddygiadol a gofal cymdeithasol, a bod mynediad amserol at wasanaethau iechyd meddwl yn anodd iawn i'w gael. Mae'r meddyg teulu heddiw yn llai o feddyg cyffredinol ac yn fwy o ymarferydd gofal cymhleth. Mae disgwyl iddynt fod ar y rheng flaen mewn perthynas ag ystod hynod o amrywiol o afiechydon. Maent yn cael eu hannog i reoli cymaint ag y gallant er mwyn tynnu'r pwysau oddi ar y sector gofal eilaidd. Fodd bynnag, er mwyn cyflawni'r amcan hwnnw, rhaid iddynt wybod i sicrwydd fod yna lu o weithwyr proffesiynol hyfforddedig y gallant atgyfeirio cleifion atynt. Yn anffodus, nid yw hynny'n wir, a dyna pam, Ysgrifennydd y Cabinet, y byddwn yn gofyn am gynllun cynhwysfawr ar gyfer y gweithlu ym mhob rhan o'r sector sylfaenol, a'i fod yn edrych ar oriau yn hytrach na phennau, ac anghenion y dyfodol a gofynion hyfforddi yn hytrach na'r status quo. Mae hyfforddiant ac annog pobl i weithio mewn gofal sylfaenol yn gwbl allweddol er mwyn cryfhau a chynllunio ar gyfer rheoli'r gweithlu yn y gwasanaethau rheng flaen. Mae'r BMA wedi tynnu sylw at y ffaith fod nifer y lleoedd hyfforddi cyffredinol ar gyfer meddygon teulu yng Nghymru, er gwaethaf ymrwymiadau gan Lywodraethau Cymru olynol dan arweiniad Llafur, yn parhau'n ddisymud. Maent hefyd yn dweud bod angen buddsoddi nid yn unig mewn hyfforddiant israddedig ac ôl-raddedig o ansawdd uchel yng Nghymru, ond mewn datblygiad proffesiynol parhaus hefyd. Mae angen i ni edrych am weithlu meddygol cenedlaethol. Mae angen i ni greu gorfodaeth i hyfforddiant meddygon iau yng Nghymru gynnwys cylchdroadau meddygon teulu fel rhan o'u hyfforddiant. Mae meddygon teulu lleol wedi ategu'r neges hon ac maent hefyd yn mynegi pryderon ynglŷn â dealltwriaeth ysgolion meddygol mewn gwirionedd o bwysigrwydd cylchdroadau fel ffordd o sicrhau nad yw ymarfer cyffredinol yn cael ei weld fel yr adran sinderela yn y proffesiwn meddygol. Ychwanegwch at hyn y farn nad yw hyfforddeion yn ystyried bod dod yn feddyg teulu yn yrfa ddymunol oherwydd costau indemniadau cysylltiedig, adeiladau sy'n heneiddio, wyddoch chi, mwy o bwysau gwaith - nid yw pobl eisiau gweithio mewn rhan angenrheidiol iawn a gwerthfawr iawn o weithlu'r GIG. Yn olaf, hoffwn droi'n gyflym at welliant Plaid Cymru, y byddwn yn ymatal arno. Nawr, rwy'n derbyn yn llwyr fod yna dystiolaeth empirig sy'n awgrymu'n glir fod myfyrwyr meddygol yn aml yn aros yn yr ardal lle cânt eu hyfforddi, ac rwy'n cydnabod bod y gwelliant hwn yn adlewyrchu'r galw gan Goleg Brenhinol y Meddygon. Fodd bynnag, ceir y fath brinder o feddygon fel y byddwn yn awgrymu os oes Albanwr, Eidalwr neu rywun sy'n byw yng Nghymru yn hyfforddi yn ein hysgolion meddygol, yna dylem eu croesawu gyda breichiau agored a cheisio'u cadw yn y wlad lle cawsant eu hyfforddi. Hoffwn ddeall yn well hefyd faint o fyfyrwyr o Gymru y gwrthodir hyfforddiant iddynt neu sy'n dewis cael hyfforddiant i ffwrdd o gartref am na allant gael lle yn lleol. Felly byddwn yn ymatal, oherwydd gallaf gael fy mherswadio os gallwch ddangos y dystiolaeth i ni. Credaf mai dadl gryfach, y bydd fy nghyd-Aelod yn ei datblygu, yw y dylem gynyddu nifer y lleoedd hyfforddi sydd ar gael ac ehangu'r ymchwil ddaearyddol. Ysgrifennydd y Cabinet, mae'n argyfwng ar ymarfer cyffredinol. Felly, i grynhoi, byddem yn hoffi gweld rhaglen recriwtio sy'n crynhoi anghenion partneriaid a theuluoedd, cynlluniau cynhwysfawr ar gyfer y gweithlu sy'n cynnwys holl haenau gofal iechyd sylfaenol er mwyn sicrhau bod ymarfer cyffredinol yn gallu atgyfeirio cleifion ym mhob man mewn modd amserol, fod yna newidiadau yn cael eu gwneud i hyfforddiant meddygon iau er mwyn sicrhau bod cylchdroadau'n cynnwys ymarfer cyffredinol fel mater o drefn a'u bod yn cael eu gwerthfawrogi fel cylchdroadau hyfforddiant ym maes cardioleg neu feddygaeth acíwt, fod adolygiad yn cael ei gynnal i'r pwysau ariannol mewn ymarfer cyffredinol, o wariant cyfalaf i yswiriant indemniad, fod pecyn cynhwysfawr yn cael ei lunio gyda byrddau iechyd a'r ymddiriedolaeth ambiwlans i wella dealltwriaeth o achosion y lefelau uchel o salwch sy'n gysylltiedig â straen y mae'r gwasanaethau yn eu hwynebu a bod rhaglen hygyrch o ymyrraeth i unigolion wneud defnydd ohoni yn cael ei rhoi ar waith, a bod llais ymarfer cyffredinol yn cael ei gryfhau a'i roi ar y blaen ac yn y canol yng nghynlluniau'r byrddau iechyd a'r Llywodraeth. Os gallwch gyflawni hyn, Ysgrifennydd y Cabinet, byddwch yn atal y storm sy'n hel yn y gwasanaethau rheng flaen, a byddwn ni, y Ceidwadwyr Cymreig, yn eich cefnogi yn yr ymdrech hon. Diolch.