General Practice: Large Housing Developments

Gavin Williamson Excerpts

Tuesday 29th March 2022 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

I beg to move,

That this House has considered general practice capacity for large-scale housing developments.

It is a pleasure to serve under your chairmanship again, Mr Dowd. I am grateful to the Backbench Business Committee for granting me this important debate and to colleagues who have come along this morning and who clearly have the same issues in their constituencies.

Every one of our constituents hugely values the ability to get a timely appointment, without too much hassle, at their local surgery. General practice is the front door of the NHS and all GPs, practice nurses, clinical pharmacists and the whole primary care team do an amazing job under enormous pressure. I express my profound gratitude to them.

In parts of England a third more GP appointments were delivered between September and November 2021 compared to the same period in 2019, yet many of our constituents regularly tell us of the difficulties they have getting a timely appointment at their surgery. GPs and primary care staff are exercised about the strain on the system. In addition, there is considerable variability in the numbers of GPs, practice nurses and people in direct patient care roles per 10,000 registered patients. I think there should be a recommendation as to how many patients a GP should have. I accept that different populations in different parts of the country will have different demands, so a number of indicative levels would be required. We have requirements in relation to the number of children who can be in a class, so why is it different for patients in GP practices?

I have analysed the numbers of GPs, practice nurses and direct patient care staff per 10,000 registered patients in each of the three primary care networks that cover my constituency and, with one exception for GPs in one primary care network, the whole of my constituency has fewer GPs, practice nurses and direct patient care staff per 10,000 patients than the averages for England and for the east of England. From the plans I have seen from my clinical commissioning group, the projected increases in primary care staff will not be enough to bring my constituency up to the average, and I am told that no figures for future GP recruitment are available from the CCG because GP recruitment is left to individual practices.

As a country, we know that we need to build more homes. and I want everyone to be decently housed. Too many people still do not have a decent home. As elected representatives, we also know that new housing development is often vigorously opposed by existing residents. That opposition has some merit to it if the existing services in that area are already under strain and are going to be put under even greater strain.

A constituent wrote to me on Saturday to say:

“Leighton Buzzard has expanded massively in the last 20 years, however the investment in infrastructure and facilities has in no way kept pace with this and access to healthcare is inadequate leaving the GP surgeries under great pressure despite the best efforts. I dread to think what the situation will be like when the massive building programme is completed.”

That is spot on. Everyone pays taxes, and those new residents will make their contribution, so it is essential and only fair that the services in an area expand as the population rises to meet that growth.

I am told that in Norwich North, the seat of my hon. Friend the Minister for Disabled People, Health and Work, who is not here to speak for herself, wave 4b CCG funding will provide an extension for one local surgery, but that will accommodate only a small fraction of the population increase and no provision is being offered for another GP practice or through section 106 money.

I understand that in the constituency of my right hon. Friend the Member for Sherwood (Mark Spencer), who, as Leader of the House, is a member of the Cabinet, 6,000 new homes are planned for Hucknall, a town where the GPs are already oversubscribed and there is no commitment to a new Cavell health centre to meet the needs of existing and new residents.

I have rarely found children without a school place to go to. However we plan for additional school capacity when massive new housing schemes come along, the system seems to work reasonably well. The classrooms get built and the teachers employed to welcome those new children and to give them a good-quality education. That is not my experience with general practice capacity, however. I represent an area that is due to have about 14,000 new homes built and that already has, before those new residents arrive, below-average numbers of GPs and primary care staff.

[Sir Gavin Williamson (South Staffordshire) (Con)]

My hon. Friend made an important point about the planning on education places. What we need to see from Government and local authorities alike is a much more robust approach to developers, to ensure that they are paying for what is required and that they are not leaving it to the NHS and local communities pick up the bill. We need to see that strong lead from Ministers, for them to be standing up for communities and not for developers.

[Andrew Selous]

I completely agree with my right hon. Friend and I defer to his expertise on education. I would add that an element of retrospection is needed, because many of those new housing estates have already been rolled out in our constituencies. The new infrastructure levy cannot be just going forward; there is an immediate deficit that we need to remedy.

The system is broken, and that is the reason I have been campaigning on the issue and have called this debate. Contributions from section 106 funding or from the community infrastructure levy often go to provide other facilities rather than for health. The guidance states:

“It is helpful if the Director of Public Health is consulted on any planning applications (including at the pre-application stage) that are likely to have a significant impact on the health and wellbeing of the local population”.

I do not think it is “helpful”—it is absolutely essential. It should be a requirement that leads to a clear outcome of additional ring-fenced health funding to employ and accommodate the necessary GPs and practice nurses that the area’s population requires.

I have good support in my request. When I put that point to the Prime Minister on 5 January this year, he replied:

“Yes...my hon. Friend…is completely right: we cannot build new homes without putting in the infrastructure to go with it.”—[Official Report, 5 January 2022; Vol. 706, c. 20.]

I can quote no higher authority, Minister.

My argument is that no new infrastructure is more important than looking after the health of the existing and new population in an area. At the moment, the system is fragmented and uncertain, in that we might be lucky and be funded through section 106 money or we might be lucky and get it from the community infrastructure levy. Again, we might be lucky and get what is needed from the housing infrastructure fund. If we are fortunate, the local authority might come to the rescue, or it could be that Treasury funding to the Department of Health and Social Care will do the job. My CCG tells me, however, that capital funding from the Treasury for new general practice capacity appears too late to be of any use in making a sensible forward plan, and disappears equally quickly.

--- Later in debate ---

[The Minister for Housing (Stuart Andrew)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I cannot think of a better way to start my day than by spending it with my colleagues. I offer my hon. Friend the Member for South West Bedfordshire (Andrew Selous) my congratulations and thanks for securing this important debate. As the hon. Member for Greenwich and Woolwich (Matthew Pennycook) said, it has been useful and wide ranging. Hon. Members will understand that I may not be able to answer a number of questions about health here and now, but I will address some of the points that have been mentioned.

My hon. Friend has been a tireless campaigner for increasing access to GPs for his constituents. I know that he and everyone here wants our constituents to have timely appointments when they need them, and I am sure that everyone will agree that waiting weeks to see a GP is simply unacceptable.

When there is a growing population and a growing supply of new homes, it falls to Government to ensure that local services are not overburdened. Part of the problem is that in the past new development has not always been accompanied by real-world improvements in local infrastructure to serve the new community. When new homes are built, roads feel busier, schools appear to be over-subscribed and appointments for local surgeries and other healthcare provision are harder to book—I see that across my own constituency of Pudsey, Horsforth and Aireborough. It is an issue that often pits communities against new development because, too often, people feel that planning is something that happens to them, not something in which they are engaged. That needs to change and I say to all colleagues here that I get it.

We need to ensure that new homes automatically translate into new infrastructure, whether that be hospitals, GP practices, schools or parks and play areas, because they are all things that we rely on. I offer my praise to GPs who have worked incredibly hard in extraordinarily difficult circumstances. My hon. Friend the Member for Loughborough (Jane Hunt) mentioned being kind to the staff at GP practices, which is an important message to relay.

It is important to say a few words about what should be happening, in order to reinforce the message to those who may be listening. Local plans are a way for areas to develop the communities they need. They are key to driving investment in the local area and securing the housing and jobs that our communities need. None the less, those plans should involve all the providers within those communities to ensure they are providing services to match the demands that new housing will bring.

[Sir Gavin Williamson]

My right hon. Friend is a thoughtful, considered and diligent Minister, and I hope he will be able to answer my question. If he does not have the answer, perhaps he can look for inspiration from his officials to his rear. Is he able to inform us how many planning applications have been turned down over the last year, two years or whatever timescale the records cover, as a result of lack of provision for health capacity and the needs of GPs? My guess is that the answer is probably zero, and that in itself sends a message to developers that they can get away with not having to bother with this.

[Stuart Andrew]

I thank my right hon. Friend for asking such a specific question. I do not have those figures to hand, but I will ensure that I get them to him. He makes a very valid point, and I will come on to some of the things that we are looking at to address exactly his points.

I was talking about local plans, which provide certainty for communities, businesses and developers. An effective and up-to-date plan is essential not only to meet an area’s housing requirements, but to create well-designed and attractive places to live, with the services that people need on their doorstep. We are already helping councils to put in place such robust and up-to-date plans. That includes encouraging visits from the Planning Inspectorate and specialist advice from the Planning Advisory Service to provide a range of specialist planning advice to councils throughout England.

Plans should be shaped by early, proportionate and effective engagement between plan makers and communities, local organisations, businesses, infrastructure providers and operators, and statutory consultees. They should seek to meet the development needs of their area, and that includes facilities that will be needed across health, schools and other areas. We recognise, however, that more work is needed. We want all infrastructure providers, including healthcare providers, to be much more engaged in the plan making right from the outset, because that is clearly not happening enough, as we have heard in the evidence of colleagues today. We will come forward on how we will do that as part of our reforms in due course.

Local plans are not the only means of improving services and building that vital infrastructure. There are clear regulatory frameworks for local authorities and developers to follow. The national planning policy framework, for example, states that local plans should aim for sustainable development, which means that new schools, hospitals and local services such as GP practices should be factored in from the outset. Proposed development should be shaped by effective engagement with the local community, so that planners and developers know what is really needed. In some areas, it might be new roads, bridges or bus depots, but in others it will be new nurseries or GP surgeries. That engagement should extend to relevant health bodies too, such as NHS trusts and the clinical commissioning groups, to ensure that any development helps rather than hinders local strategies to improve health and wellbeing.

Local healthwatch organisations have a role to play. They have a firm grasp on the concerns of people who use health and social care services. My Department strongly encourages planning authorities to consult them when new homes are being built, so that they can raise those all-important questions on the number of GPs needed. Equally, to some extent local plans should head some of that off before houses are actually built. I have, however, listened to what colleagues have said—I hear it loud and clear. Put simply, if a GP surgery is right in the centre of town and a new development is on the outskirts, it is obviously better to ensure that a new surgery is built closer to the homes it will serve.

We have touched on some of the funding. Hon. Members are aware that councils obtain contributions through a community infrastructure levy on new development and by negotiating section 106 planning obligations with a developer. That helps to create funding not just for housing, but to address local infrastructure needs. In the constituency of my hon. Friend the Member for South West Bedfordshire, about £5.5m has been allocated to healthcare provision through such funding, and that should be spent on helping to provide GP practices.

I recognise, however, that there is an issue here about which we need to do more. We hope that part of the effective planning reforms that we are to introduce will answer some of that. Our ambition has always been to simplify the system and to ensure that development becomes synonymous with improved services, and healthier and happier neighbourhoods. That is why we are exploring the introduction of a new infrastructure levy to replace the existing system of developer contributions.

At the moment, we plan for that new levy to be payable on completion of development. That will replace the negotiation and renegotiation that we keep seeing happen. The new levy will not be negotiable and will maximise land value, so we get more for local communities. It will also bring much greater certainty on costs, on factoring expenditure into the price paid for land and, in turn, on delivering more vital infrastructure. Under our proposals, local authorities would be allowed to borrow against infrastructure levy revenues so that they could bring forward vital improvements to services, including expanding GP capacity, before the first spade of a new development even hits the ground.

That said, I recognise that we need to test the policy. Many issues have been raised. I cannot at this moment commit my right hon. Friend the Prime Minister to a meeting, but I will raise with him the suggestions and comments made today, and I will meet my colleagues in the Department of Health and Social Care to raise the points made, to ensure that we are prioritising, gearing up and keeping focus, so that we can see what more can be done, and so that we do not miss the opportunity provided by the new fund to get the necessary infrastructure.