Professor Robert Harris: Not Building the Dream

Professor Robert Harris

Professor Robert Harris

January 14, 2020 | @ProfRHarris

As the population grows, the demand on our NHS grows. We know that. However, the currency of demand is too often just described in terms of ‘units’ of GPs or nurses or appointment slots.

Whilst of course workforce sustainability has to be our top priority to fix, we also have major issues with our NHS real estate, especially GP premises.

My organisation operates in parts of the country where there are substantial new housing programmes – homes already newly built; in current construction; or planned. In the East Midlands, Corby is often cited as the fastest growing town in the country. In East of England, our surgery sites in Cambridgeshire are seeing huge swathes of the county transformed into new estates. The same is happening across the country.

Vast profits are being made by developers who are building these new dwellings. A usual part of any planning process is that developers and land owners have to contribute something of ‘value’ back to the locations they are developing. This usually comes in the form of social housing contribution and/or an agreed cash contribution via a Community Infrastructure Levy (CIL) or a Section 106 contribution.

Given the tens of thousands of new homes being built in the region where we provide primary care services, we anticipate a huge surge of citizens wishing to register with us as patients. This is particularly true in towns like Stamford in Lincolnshire, where we are the sole provider of GP services to the town’s current 32,000 citizens, with this figure expected to grow under the agreed Town Plan over the next few years to an excess of 50,000 citizens. The same is true in St Neots, Peterborough and several other towns where we operate.

In each instance the Local Planning Authorities are in receipt of funds (to varying degrees) from developers, but – as shown by Reform’s research – are largely failing to pass them through to General Practice to help upgrade and extend existing premises in order to cope with patient demand growth.

Why this is the case is a contribution of a couple of things: firstly, Local Authorities have been amongst the hardest hit in terms of budgetary cuts over the past decade. This means there is huge pressure on budgets for schools, roads, civic amenities and of course, health centres. So, any Section 106 contribution has many calls on its use. Secondly, GP partnerships are not statutory consultees in any planning process. This means that CCGs need to be aware of any population growth and new homes construction, and be at the table when funding contribution discussions take place. More often than not they are absent from such discussions.  This means the NHS is not represented, and therefore overlooked.

It is right that any developer making vast profits from house building should make a significant contribution to the social infrastructure cost of servicing new residents, particularly the cost of expanding healthcare facilities.

I suspect if new home buyers were told that the existing GP infrastructure could not cope with the influx of new residents, they may think twice about any house purchase – especially if the purchasers are looking at retirement type homes.

Therefore to ensure that local primary care provision doesn’t collapse under the weight of local population growth, CCGs need to ensure that they are present at every planning meeting where Section 106/CIL contributions are being discussed, and need to make a strong case on behalf local GPs for such funds to be hypothecated to them.  If this doesn’t happen, and the funds are not used productively, I fear for the future of GP infrastructure and service provision.

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