General Practice: Large Housing Developments

Andrew Selous 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.

[Theresa Villiers (Chipping Barnet) (Con)]

Does my hon. Friend agree that while developers sometimes offer to create new premises for additional GP practice, that does not resolve the problem? The shortage is of people, of qualified GPs, so even if there are brand-new premises, without the doctors to see the patients, the problem he is talking about is not solved.

[Andrew Selous]

This is the benefit of having former members of the Cabinet in a debate such as this: they know what they are talking about. My right hon. Friend is completely right. We are talking about capital and ongoing revenue funding. Those new residents come with a stream of tax revenue—their council tax, their income tax and the tax from their businesses, which they will pay—so we are not asking for anything unreasonable; it is about an equitable allocation given where people live, when there are big increases in the local population.

In my local authority, there were proposals to build four health hubs. The original commitment was that those would be built by 31 March 2020, then by 2024, and we have one being built, another progressing, and complete silence on the other two. Initially, the funding was due to come from the primary care infrastructure fund, then the primary care transformation fund, with the CCG and the local authority due to make contributions at various points—but none of those routes has led to the delivery of two much-needed health hubs in my constituency.

I propose that there should be guaranteed primary care health funding for each 1,000 new homes, allocated at the time planning permission is granted and delivered as the new residents arrive, although smaller developments must also be catered for.

The current capitation figures, based on the Office for National Statistics population figures, always lag. Therefore, the infrastructure always comes too late, leaving unacceptable strain on local primary care services. We will, in the end, pay for the primary care services needed but, instead of always doing it too late, let us get ahead of the curve and stop the anxiety and upset that our constituents and primary care staff experience as a result.

I observe that the process is often shrouded in secrecy, with very little engagement with local Members of Parliament and councillors. We are the ones who feel the anger of our residents when these facilities arrive too late, but there is limited local accountability from those taking the decisions, and a confused and uncertain national funding process. We could learn from the way education funding is allocated to accommodate significant population growth. I recommend that the Prime Minister urgently convene a Cabinet Sub-Committee between the Treasury, the Department of Health and Social Care and the Department for Levelling Up, Housing and Communities, to deal with the issue once and for all.

I repeat the point I made to my right hon. Friend the Member for Chipping Barnet (Theresa Villiers). I understand that the new infrastructure levy may come to our rescue, but if it just looks forward and does not deal with these vast new housing estates—14,000 homes being built in my constituency and many thousands in the constituencies of colleagues here—we will have let down our constituents. Our country generally does public administration well; we are better than this and can fix it. I implore the Minister to go back to his Secretary of State to have a focused, cross-Government effort, led by the Prime Minister, to get this right once and for all.

--- Later in debate ---

[Andrew Selous]

Let me start by offering my huge thanks to all colleagues who have taken the time and trouble to come here and be incredibly articulate on behalf of their communities, because this is clearly a common problem. We have heard from Members representing areas from Keighley to Cornwall and all points in between, and I know that colleagues from the north-west, Oxfordshire and many other places were not able to be here to tell the stories of their constituencies.

I have been reflecting on what the Minister has said. When he described the current system, I heard the word “should” a lot, but in moving to the new system of the infrastructure levy, that word must change to “must”. In far too many cases, “should” simply has not resulted in delivery. At the heart of it, I think we can do this according to the numbers. A GP and primary care team should be able to expect a safe limit based on the population in their area. A younger, healthier population could have a larger limit, but a smaller patient load may be required in an area with an older, more disadvantaged population.

If we agree that there is a safe number of patients for a primary care team of GPs and practice staff, we can simply do it on the numbers and raise up those affected. When many more houses are built, we must have the additional capacity to serve those extra residents coming to the area. I hope that the infrastructure levy will provide everything we need, but when the Minister has that conversation with the Department of Health and Social Care, could he please invite the Treasury to that meeting as well? Quite frankly, if the infrastructure levy does not do the full job, we will have to go back to the Treasury. We will pay for this eventually, but we need to do it in a timely manner.

My final point is incredibly important. What the Minister is about to bring in must not just be future-looking. We all now have massive estates that are under-provisioned. He cannot just look to the future; he must deal with the current problem, which the existing system has allowed to get into a terrible state.

Question put and agreed to.

Resolved,

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