The Minister for Community and Social Care (Alistair Burt)
I thank my hon. Friend the Member for Rugby (Mark Pawsey) for bringing the debate to the House, and for the courtesy and kindness with which he has described my role. I certainly get it. I certainly get the frustrations involved in dealing with property matters in relation to the NHS, matters to which I have become more accustomed in the past nine months or so. I wish I was able, at the conclusion of my remarks, to give him all the assurances he wants, but as the NHS is an independent body I cannot quite do that. However, we can, perhaps, get somewhere towards it, because of how he has brought the case and defended his constituents’ interests.
My hon. Friend has fairly described the issues in his community of Brownsover, with its mix of peoples and complex needs. The medical centre is a matter of extreme concern to his constituency. The uncertainty over the future provision of GP services in Brownsover has continued for more than a year, and that is only the latest chapter in the catalogue of events that he described. It is clearly unacceptable to him and his constituents. I am fully aware that local people and patients have expressed their frustration in a number of ways. I know he shares that feeling, and so do I. I will say a little about the general position of our GPs, their premises and the pressures they are under, and then turn to the particular.
Like every other part of the country, Brownsover needs good local health services, in particular its local GPs. General practice is the bedrock of the NHS and it is at the heart of this vision. It reflects the GP’s key role in providing continuity of care, which is especially important to people with long-term health conditions; the importance of expert generalists, doctors and wider practice teams who look at the whole person, including their medical, social and psychological needs in the round; the fact that general practice is rooted in local communities; and the key role of general practice in public health in immunisation and screening programmes. We ask our GPs to look after people from cradle to grave, and to know when and where to refer patients when specialist care is needed. We also expect them to commission much of the specialist care provided in hospitals.
The key factors affecting the environment within which general practice works, and the challenges and the opportunities they present, include: an ageing population, with increasing numbers of people living with multiple health conditions; higher public expectations, linked to the role of digital technology; a very constrained financial position over the past five years, with general practice seeing a steady decline in its share of the overall NHS budget, albeit after a rapid growth in resources after the 2004 GP contract; and a change in the structure of practice, including a struggle to maintain partners, a growing proportion of salaried GPs, a growing number of GPs wanting to work part time—not just women, but men—and a rise in portfolio careers.
There has been an increase of about 25% in GP consultations since 1998—an estimated 340 million consultations every year. That is the work we expect our GPs to do and which they perform extraordinarily. Within five years, we will be looking after 1 million more people over the age of 70. Quite simply, if we do not find better and smarter ways to help our growing elderly population to remain healthy and independent, our hospitals will be overwhelmed. That is why we need effective, strong and expanding general practice more than ever before in the history of the NHS—an NHS committed both through its premises and through its commissioning to respond to the sorts of pressures my hon. Friend rightly described in relation to Brownsover.
At last year’s election, we committed ourselves to the challenging objective of increasing the primary and community care workforce by at least 10,000 and ensuring that 5,000 more doctors work in general practice, as well as more practice nurses, district nurses, physicians, associates and pharmacists. We will focus recruitment on the most under-doctored areas, where the problems are most acute. Since 2010, the GP workforce has already increased by 5%, with an additional 1,700 GPs working or in training. Over 90% of all NHS patient contact happens in general practice. The average person in England sees their GP six times a year.
All that has profound implications for how general practice works—for the clinical model, the business model and the career model—but, under all that pressure, the profession is rising to the challenge. Practices are increasingly coming together in federations or networks to build on all the traditional strengths of general practice, working at a greater scale to improve efficiency and spread innovation to offer a range of services they struggle to provide individually. There is a strong push towards greater integration with community health services, mental health services, social care and some specialist services, and there is increasing use of the wider primary care team, including nurses and particularly pharmacists.
That is the background to the work, the concerns about general practice and how the Government intend to meet the challenges by delivering pilot projects and vanguards and by looking at different ways of providing GP services. However, people need premises to work out of, so I will now turn to the circumstances that my hon. Friend described. This matter goes back some time, but I can deal in detail only with the events since the notice of closure last year. I am grateful to him and representatives from NHS England and NHS Property Services for meeting me recently to discuss the matter in the round.
The Albert Street medical practice in Rugby and its branch surgery in Bow Fell, Brownsover, closed in April 2015, and Rugby Town medical practice took over the provision of GP services for the patients affected, with the expectation, at the time, that a new practice in Brownsover would open in 2016. In November 2015, representatives of NHS Property Services met NHS England and the Coventry and Rugby clinical commissioning group, and subsequently the Department of Health, and it was agreed that NHS Property Services would be the lead property company supporting NHS England on the development of the new Brownsover facility. NHS England is the lead organisation for the new development.
At a meeting with members of the Brownsover patient action group and my hon. Friend, NHS England explained that the business case previously approved for the development required reviewing because of the change in the size of the development and the change to the lead organisation. A project team, which included members from NHS Property Services and NHS England, was set up to determine the most appropriate method for delivering the scheme. Additional information required for the development of a new business case is now in place. At a meeting with me and my hon. Friend on 22 February, NHS England in the west midlands confirmed that a decision to award a contract would be made that week, and the partner has now started work. This included an initial meeting, on 29 February, with NHS England, the community health partnership and a representative of the Brownsover patient action group.
As I indicated to my hon. Friend, the provision of premises in the NHS is not always straightforward. Ownership of existing premises tends not to be in the same hands—they might be owned by a former GP, a property company or the NHS itself—and all the issues connected with the division of proceeds of land and the need to move carefully on planning come into play even for GP premises and services. Add to that the uncertainty around new developments and the like, and the difficulties, although frustrating, can mount, and that has been the situation here.
Some questions and answers might help my hon. Friend and his constituents. Patients in Brownsover were told that their facility would open this year. When can they now expect it? I understand that NHS England has updated him, as he said, and he is now aware that a contract was awarded on 24 February, but a full business case needs to be developed, which NHS Property Services estimates will take nine months to produce. There will then be a two-month period in which to reach financial close, and around a year for construction and commissioning.
I will say a little about that because it is complex and it might help my hon. Friend’s constituents and others if I put it on the record. It may also help me, in dealing with NHS Property Services, to see how we might streamline the processes rather more than they are streamlined at the moment.
The outline business case and full business case process is an NHS England requirement for commissioners to progress where public capital funds are being invested. Commissioners are required to develop and update an estate strategy that aligns with their commissioning strategy. For very large investments, it might be expected that a strategic outline case is produced. This aims to ensure that all relevant parties are signed up to the associated expenditure.
The clinical commissioning group has included the proposed new Brownsover surgery in its strategic estates plan. This is fundamental if NHS England and the CCG apply for primary care transformation funds or customer capital investment moneys. Once the capital investment has been approved in the estates strategy, the scheme moves forward to an outline business case, and demonstrates the options, costs and benefits. There may be some preliminary design work to establish that planning consent will be achievable. The outline business case also sets out the preferred option and confirms affordability. Because there are different methods of procurement, the outline business case will establish the preferred procurement route and identify the source of funding.
Once the preferred option is identified and approved as being value for money and affordable, the case moves on to the more detailed design and costing to confirm that it meets all requirements and that the budget is set. Again, this detailed work is used to confirm value for money and affordability. The timescales for each stage tend to vary depending on the complexity and scale of the business case.
The Brownsover case is relatively small and less complex than some, but it still involves an option appraisal, land acquisition, design and costing, planning application, procurement tendering processes, agreements for lease and then construction. The House will be glad to know that NHS Property Services advises that it has streamlined its approvals requirement so that investment capital or lease acquisition requires executive approval by two directors and does not need to go before a committee.
That outlines some of the issues pertaining to the background and the agreements that need to be put in place before planning permission can be approved and the matter can move forward. The timetable will be determined partly by the commissioners’ approval process and partly by NHS Property Services procurement route.
“Why so long?”, patients will ask, and they will say that it is a bureaucratic mess. Well, it perhaps sounds more complex than it might be, but this is a public scheme with public value for money, and detailed work is needed to confirm that value for money and affordability. While the Brownsover case is relatively small and less complex, it still involves, as I said, an option appraisal, acquisition, design and costing, planning application, tendering, agreements for lease and then construction.
It must be frustrating for patients and for my hon. Friend to hear all that set out, but in all honesty, I felt that I had to do so. It is not all the fault of those handling property services. They know that if there is a flaw in their process and something goes wrong, they will be hauled over the coals. However, the mere recitation of the process—to you, Madam Deputy Speaker, and to the House—gives rise to the thought that perhaps somewhere, something might be telescoped to give patients the hope that an element of urgency might be produced, particularly where a closure has been in place and it was anticipated for some time before that that new premises might be available. In those circumstances, it is perhaps the Minister’s job to stay on hand with my hon. Friend to make sure that any such urgency flows into the system.
In conclusion, I can confirm that NHS England now believes that the previously approved business case had to be reviewed because of the changes in the size of the development, but it is working on amending the business case and I am told that it will be completed shortly. Once that has been done, NHS Property Services will be in a position to decide how the Brownsover scheme is to be delivered. Although it seems it will not be built in 2016, the fact that progress has been made—in no small measure due to my hon. Friend’s activity—means, I hope, that there will be good news in the future. The closure was not of NHS England’s own choosing, and it has had to respond to that fact. The difficulties outlined by my hon. Friend, together with the frustrations involved in dealing with the complexity of the building processes, have combined to make the situation for patients sadly more difficult than it should be, but there have been reasons for that.
I hope that we can now move on, given the determination of NHS Property Services to fulfil the commitment that it has given to me, and to my hon. Friend, to do all that it can to work with him and with the patients. It is working very hard in that regard, and I pay tribute to those who are now involved in the process of moving that work forward. I pay tribute to the patients for their own patience. Perhaps in due course, they will have the new facility that they so richly deserve.
Question put and agreed to.