Jeffrey Ng MRTPI is a Primary Care Lead – Estates at NHS Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (ICB). Jeffrey is the winner of the RTPI South East Young Planner of the Year 2018, the commended RTPI South East Young Planner of the Year 2024 and the finalist of the RTPI Young Planner of the Year 2020 and 2021. He is also the former Young Planners Trustee of the RTPI.
“The primary care estate is plainly not fit for purpose”. This is a statement abstracted from Lord Darzi under his recent Independent Investigation of the National Health Service in England report to the Secretary of State. Lord Darizi’s statement indicates that a swift response is required to ensure primary care estates are sustainable and fit for purpose.
While this may be easily done by providing a new GP surgery or redeveloping the existing GP premise, a recently scrapped plan for a new GP surgery in Maidenhead due to rising construction costs and interest rates, sets out that it is not an “easy” task. While local plans require sufficient infrastructure to be delivered to support new developments, the lack of GP provision remains a nationwide issue. This indicates that there is a “disconnect” between primary care and planning.
A GP surgery had been proposed for the site of the demolished Waldeck House (© Google Maps)
Role of Integrated Care Boards and how GPs are indirectly funded
ICBs are statutory NHS organisations which replaced former Clinical Commissioning Groups (CCGs). ICBs have a responsibility to ensure all primary care provisions are operationally and financially viable. However, there is no dedicated ICB funding to support any primary care estates projects. This indicates that any new GP surgeries or projects to extend or reconfigure any existing GP premises to increase clinical space will need to be funded by developer contributions or CIL. While CIL is to be used to fund infrastructure, there is no legal requirement for local planning authorities to allocate designated CIL funding towards primary care. It implies that ICBs will need to compete with other infrastructure providers for CIL.
Plan-making – primary care and planning
In plan-making, the National Planning Policy Framework requires all strategic policies to make sufficient provision for community facilities such as health and the contributions expected from development. Local planning authorities are keen to work with ICBs to ensure adequate primary care services can be provided and delivered to both existing and new residents. One of the key challenges is that there is a lack of strategic GP planning. GP catchment areas usually overlap each other and can cover more than one local planning authority. Also, different GPs have different contractual arrangements as some premises are owned by GPs, but some GPs are only the tenants of the premises. The lack of dedicated funding to support any primary care estates projects from ICBs indicate that ICBs can struggle to include any potential projects in infrastructure delivery plans (IDPs), which are one of the key documents produced by local planning authorities to set out a list of required infrastructure in local areas.
Decision-making – primary care and planning
In decision-making, ICBs are not statutory consultees. Therefore, it is entirely subject to an agreed consultation procedure between ICBs and the individual local planning authority. While different local planning authorities have different approaches in assessing developer contribution requests, it implies that ICBs can fail to secure any developer contributions. The timescale of receiving developer contributions towards primary care is another issue. This high level of uncertainty of securing developer contributions would have a significant implication to any planned primary care estates projects. Importantly, developer contributions can only support any primary care estates projects which are intending to increase the GP capacity for the new population generated instead of resolving the existing capacity issue of GPs.
Delivering new surgeries
In terms of delivering new GP surgeries, this can be achieved by having a new “main” GP surgery or by having a new “branch” GP surgery. One of the key challenges for ICBs is to find a GP provider to operate this new surgery. In order to achieve this, one option is to get an existing GP provider to relocate to this new surgery or to operate this as a new “branch” surgery. From a GP perspective, operating a new “branch” surgery is usually not preferred due to the ongoing nationwide GP workforce issues and there will be a rent implication to ICBs. Relocation of an existing GP surgery can be achievable. However, unless it is a “branch” surgery to serve the new development only, it implies that developers will need to provide a surgery which can accommodate both new patients and the existing patients. It means that developers will need to deliver this on a voluntary basis. Similar to receiving developer contributions, the timescale of delivering a new GP surgery is subject to the delivery of the permitted development schemes. This high level of uncertainty in timescale, again, would have a significant implication to the delivery of any new GP surgeries.
Way forward – what’s next?
In the recently closed public consultation to the proposed reforms to the National Planning Policy Framework and other changes to the planning system, one of the proposed changes is to reinstate the importance of strategic planning and to further support effective co-operation on cross boundary and strategic planning matters. This can be a potential “game changer” of the current dilemma as it implies that primary care can be a strategic consideration.
In terms of infrastructure delivery, it is also time to review the current IDP system and whether the current system is “fit for purpose”. For any new developments, there is a need to ensure infrastructure can be delivered at a timely manner and is financially viable. This can only be achieved by a collaborative effort among developers, local authorities, ICBs, local communities and other key stakeholders.
There is no room to tolerate another scrapped GP surgery in our community. In my view, planning plays a key role to help rebuild the NHS system and to ensure our primary care estates are “fit for purpose” and financially viable. Now is the time to reconnect planning and primary care.
