English: Thank you, Deputy Presiding Officer, and I do move the amendments that I have tabled. Now, to listen to the Minister for Health and Social Services, you would imagine that everything's hunky-dory in our primary care services across Wales, but, of course, nothing could be further from the truth. The primary care model for Wales is underpinned, really, by the GP services that many people, of course, enjoy as the front-line health service that they access, but, of course, we know that there is a significant crisis in GP recruitment at the moment that will undermine the delivery of the primary care model that the Welsh Government aspire to. Now, we've been warning about this GP crisis, along with the British Medical Association and the Royal College of General Practitioners, for many, many years. We were telling you to ramp up the number of training places almost a decade ago, and yet you have failed to do so up until recently. And even now, even with the ongoing shortages, we are still in a position where there are more individuals applying for those courses and eligible for those courses, in terms of being able to train in the GP specialism, yet you are knocking them back. This is in spite of the fact that we have got, according to the BMA, 24 GP practices that have closed across Wales, 29 that are managed by the health board and 85 that are at risk. Now, this situation cannot go on. You need to train more GPs and ramp up the opportunities for training as soon as possible. On top of that, the Royal College of GPs, in their most recent survey, found that 23 per cent of GPs have said that they're unlikely to be working in general practice in five years' time. That's almost a quarter of the GP workforce. Seventy-two per cent tell us that they expect working in general practice to get worse over the next five years, and 42 per cent say that it's financially unsustainable to run their practices. So, I think that things are far less rosy than the Minister has tried to present today. We know also that managed practices, which are one of the things that the Government has highlighted as something that they want to see more of within the mix, are actually a lot more expensive - a third more expensive than the GP contractor role, which most people see as the traditional GPs in their local communities. Now, if you made the resources available that you're currently giving to those managed practices to the GP practices that are at risk, I think you'd find that many GP practices would no longer be at risk and would actually be managing quite well, thank you very much. In terms of the applications - just in north Wales, by the way, we've seen closures of practices in Wrexham and elsewhere in north Wales, including in my own constituency, and yet there were 50 per cent more applicants than the number of individuals who were actually given training places on the GP specialism over the last year. So, 2017 figures suggested that there were 22 applicants, and yet just seven were offered places in Wrexham; 24 applicants in Bangor, yet just 12 were offered places - and this is in spite of the fact that we've got a dreadful GP shortage. So, I think that you need to look very carefully at those GP numbers, or else, frankly, your primary care plan is not going to work. Now, on top of that, you're also making it less attractive to come and work in Wales and be a GP practitioner, because of the indemnity situation, which you barely touched on in your opening remarks. It's not surprising that you barely touched on it, of course, because what you're actually doing is top-slicing the income of GP practices, taking £11 million out of the cash available to support those practices in order to introduce a GP indemnity scheme, quite different than the current situation in England where they've had a significant uplift - [ Interruption.] - where they've had a significant uplift - [ Interruption.] You're not listening to me - where they've had a significant uplift in the income that is available to them in the same year that they had their indemnity insurance scheme. Bear in mind, it's not me saying this; this is the GPs themselves who contact me and contact you, and no doubt contact everybody else in this Chamber. Dr Philip Banfield, a representative of the BMA council in my own constituency, said it's 'having an immediate and catastrophic collapse of morale from GP colleagues in North Wales'. Dr Conor Close, also a GP in my own constituency, says that the cut is a step too far for his surgery and that, I quote, 'Reducing the global sum is potentially the final straw in the long-term viability of the practice'. You mentioned the situation with locum lists. As I understand it, this is going to add a new differential between Wales and England, and, in addition to that, you're saying that you're going to pay for the insurance for the locums. You're not going to top-slice their income, which is going to drag more and more people into locum work and away from the less expensive way of running things in their GP practices. So, we need a radically different approach. One final point, if I may, Madam Deputy Presiding Officer, and that is in respect of the share of investment as a total of the whole budget in the NHS. Wales has the lowest percentage of NHS budget invested in its primary care services versus any other part of the UK: 7.64 per cent, according to the statistics that I have, compared to 9.51 per cent in England being spent on primary care, 7.75 per cent in Scotland, and 9.51 per cent in Northern Ireland. Clearly, what you're doing is you're starving our primary care services at a time when they need significant investment, and I would urge you to take a different strategy forward, and I urge people to support the amendments that we have tabled.
Welsh: Diolch, Dirprwy Lywydd, ac rwyf yn cynnig y gwelliannau yr wyf wedi'u cyflwyno. Wrth wrando ar y Gweinidog Iechyd a Gwasanaethau Cymdeithasol, byddech chi'n dychmygu bod popeth yn fendigedig yn ein gwasanaethau gofal sylfaenol ledled Cymru, ond, wrth gwrs, dim o'r fath beth. Mae'r model gofal sylfaenol i Gymru wedi'i seilio, mewn gwirionedd, ar wasanaethau meddygon teulu sef y gwasanaethau iechyd rheng flaen y mae llawer o bobl yn eu defnyddio, ond, wrth gwrs, gwyddom ni fod argyfwng sylweddol o ran recriwtio meddygon teulu ar hyn o bryd a fydd yn tanseilio'r broses o ddarparu'r model gofal sylfaenol y mae Llywodraeth Cymru yn awyddus i'w ddarparu. Nawr, rydym ni wedi bod yn rhybuddio ynghylch yr argyfwng meddygon teulu hwn, ynghyd â Chymdeithas Feddygol Prydain a Choleg Brenhinol yr Ymarferwyr Cyffredinol, ers blynyddoedd lawer. Roeddem ni'n dweud wrthych am gynyddu nifer y lleoedd hyfforddi bron i ddegawd yn ôl, ac eto yr ydych wedi methu gwneud hynny tan yn ddiweddar. Hyd yn oed nawr, hyd yn oed gyda'r prinder parhaus, rydym ni'n dal mewn sefyllfa lle mae mwy o unigolion yn gwneud cais am y cyrsiau hynny ac yn gymwys ar gyfer y cyrsiau hynny, o ran y gallu i hyfforddi ym maes arbenigedd meddygon teulu, ac eto rydych chi'n eu rhwystro nhw. Mae hyn er gwaethaf y ffaith bod gennym ni, yn ôl Cymdeithas Feddygol Prydain, 24 o bractisau meddyg teulu wedi cau ledled Cymru, 29 sy'n cael eu rheoli gan y Bwrdd Iechyd a 85 sydd mewn perygl. Ni all y sefyllfa hon barhau. Mae angen i chi hyfforddi mwy o feddygon teulu a chynyddu'r cyfleoedd ar gyfer hyfforddiant cyn gynted â phosibl. Ar ben hynny, canfu Coleg Brenhinol y Meddygon Teulu, yn ei arolwg diweddaraf, fod 23 y cant o feddygon teulu wedi dweud eu bod yn annhebygol o fod yn gweithio ym maes ymarfer cyffredinol ymhen pum mlynedd. Mae hynny bron i chwarter y gweithlu meddygon teulu. Mae 72 y cant yn dweud wrthym ni eu bod yn disgwyl y bydd gweithio mewn practis cyffredinol yn gwaethygu yn ystod y pum mlynedd nesaf, ac mae 42 y cant yn dweud ei bod yn anghynaliadwy yn ariannol i gynnal eu practisau. Felly, credaf fod pethau'n llawer llai gobeithiol nag y mae'r Gweinidog wedi ceisio'i gyflwyno heddiw. Gwyddom ni hefyd fod practisau a reolir, sy'n un o'r pethau y mae'r Llywodraeth wedi tynnu sylw ato fel rhywbeth y mae hi eisiau gweld mwy ohonyn nhw yn y gymysgedd, yn llawer drutach mewn gwirionedd - traean yn ddrutach na swydd y contractwr meddyg teulu, y mae'r rhan fwyaf o bobl yn eu gweld fel y meddygon teulu traddodiadol yn eu cymunedau lleol. Nawr, petaech chi'n darparu'r adnoddau hynny yr ydych chi ar hyn o bryd yn eu rhoi i'r practisau sy'n cael eu rheoli, i'r practisau meddygon teulu sydd mewn perygl, rwy'n credu y byddech chi'n gweld na fyddai llawer o bractisau meddygon teulu mewn perygl mwyach ac y bydden nhw'n ymdopi'n eithaf da, diolch yn fawr. O ran y ceisiadau - yn y gogledd yn unig, gyda llaw, rydym ni wedi gweld practisau yn cau yn Wrecsam ac mewn mannau eraill yn y gogledd, gan gynnwys yn fy etholaeth i, ac eto yr oedd 50 y cant yn fwy o ymgeiswyr na nifer yr unigolion a gafodd leoedd hyfforddi yn arbenigedd y meddyg teulu dros y flwyddyn ddiwethaf. Felly, roedd ffigurau 2017 yn awgrymu bod 22 o ymgeiswyr, ac eto dim ond saith a gafodd gynnig lle yn Wrecsam; 24 o ymgeiswyr ym Mangor, ond 12 yn unig a gafodd leoedd - ac mae hyn er gwaetha'r ffaith bod gennym ni brinder ofnadwy o feddygon teulu. Felly, credaf fod angen ichi edrych yn ofalus iawn ar niferoedd y meddygon teulu, neu fel arall, a bod yn onest, nid yw'ch cynllun gofal sylfaenol yn mynd i weithio. Ar ben hynny, rydych chi hefyd yn ei gwneud hi'n llai deniadol i ddod i weithio yng Nghymru ac i fod yn ymarferydd cyffredinol, oherwydd y sefyllfa o ran indemniad, prin ichi grybwyll hyn yn eich sylwadau agoriadol. Nid yw'n syndod ichi roi cyn lleied o sylw i hyn, wrth gwrs, oherwydd yr hyn yr ydych yn ei wneud mewn gwirionedd yw brigdorri incwm practisau meddygon teulu, gan gymryd £11 miliwn o'r arian sydd ar gael i gefnogi'r practisau hynny er mwyn cyflwyno cynllun indemniad meddygon teulu, a hynny'n lled wahanol i'r sefyllfa bresennol yn Lloegr lle maen nhw wedi cael cynnydd sylweddol - [ Torri ar draws.] - lle y maen nhw wedi cael cynnydd sylweddol - [ Torri ar draws.] Nid ydych yn gwrando arnaf fi - lle y maen nhw wedi cael cynnydd sylweddol yn yr incwm sydd ar gael iddyn nhw yn yr un flwyddyn ag y maen nhw wedi cael eu cynllun yswiriant indemniad. Cofiwch, nid fi sy'n dweud hyn; y meddygon teulu eu hunain sy'n cysylltu â mi ac sy'n cysylltu â chi, ac mae'n siŵr yn cysylltu â phawb arall yn y Siambr hon. Dywedodd Dr Philip Banfield, cynrychiolydd o gyngor Cymdeithas Feddygol Prydain yn fy etholaeth i: bod morâl meddygon teulu yn y gogledd yn chwalu'n ddi-oed ac mewn modd trychinebus. Mae Dr Conor Close, sydd hefyd yn feddyg teulu yn fy etholaeth i, yn dweud o ran ei feddygfa ef, bod y toriad yn gam yn rhy bell, ac fe ddyfynnaf; Lleihau'r swm craidd yw'r ergyd olaf o bosibl o ran hyfywedd hirdymor y practis. Fe wnaethoch chi sôn am y sefyllfa o ran rhestrau locymiaid. Yn ôl yr hyn a ddeallaf, mae hyn yn mynd i ychwanegu gwahaniaethu newydd rhwng Cymru a Lloegr, ac, ar ben hynny, rydych yn dweud eich bod yn mynd i dalu am yr yswiriant ar gyfer y meddygon locwm. Nid ydych yn mynd i frigdorri eu hincwm, sy'n mynd i lusgo mwyfwy o bobl i waith locwm ac i ffwrdd o'r ffordd lai costus o gynnal pethau yn eu practisau meddygon teulu. Felly, mae angen dull o weithredu sylfaenol wahanol arnom ni. Un pwynt olaf, os caf, Madam Ddirprwy Lywydd, ac mae hynny'n ymwneud â'r gyfran o fuddsoddiad fel cyfanswm y gyllideb gyfan yn y GIG. Mae gan Gymru'r ganran isaf o gyllideb y GIG wedi'i buddsoddi yn ei gwasanaethau gofal sylfaenol nag unrhyw ran arall o'r DU: 7.64 y cant, yn ôl yr ystadegau sydd gennyf fi, o gymharu â 9.51 y cant yn Lloegr yn cael ei wario ar ofal sylfaenol, 7.75 y cant yn yr Alban, a 9.51 y cant yng Ngogledd Iwerddon. Yn amlwg, yr hyn yr ydych yn ei wneud yw amddifadu ein gwasanaethau gofal sylfaenol ar adeg pan fo angen buddsoddiad sylweddol arnyn nhw a byddwn yn eich annog i ddatblygu strategaeth wahanol, ac anogaf bobl i gefnogi'r gwelliannau yr ydym wedi'u cyflwyno.