The Committee received a joint presentation
from the Integrated Care Board (ICB) and the County Council. The
presenters were Simon Doble of the C&W ICB and Janet Neale from
WCC’s Infrastructure Team. Tim Sacks (ICB) was also present
to respond to questions. In opening the item, the Chair mentioned
that the focus was on estates aspects rather than access issues.
Janet Neale commenced the presentation covering the following
areas:
- The Local Plan process, with an outline of the key
stages leading to formal adoption of the Local Plan. There was a
clear need for both WCC and the ICB to be very involved in this
process.
- Section 106 (S106). This was a legal
agreement between local authorities and landowners/developers
detailing obligations required as a result of a planning
application. Effectively it was a charge against the land.
- Community Infrastructure Levy (CIL).
A tax on net new floor space set locally and paid to the district
or borough council. The requirements around levying and use of CIL
were outlined. In Warwickshire to date, only the Stratford and
Warwick Districts had adopted CIL, with Rugby Borough pursuing the
use of CIL currently.
- Further slides showed the pros and
cons of the S106 and CIL approaches.
- The proposal to introduce a new
mandatory Infrastructure Levy, set locally (similar to CIL). This
would be based on the assessed uplift value of the land, as a
result of development. This approach had attracted strong challenge
during the consultation process by a wide range of
organisations.
Simon Doble then spoke to the NHS aspects:
- Primary Care Estate Context. This
included the transfer from the former Clinical Commissioning Groups
(CCGs), frustrations for general practice and responding to known
population growth with limited funding.
- Primary Care Estate Environment.
This confirmed there was no new funding, a historic lack of
investment, before raising the challenges from existing funding
streams, build costs, workforce aspects and ownership of
premises.
- The current picture. A slide giving
an understanding of the ICB’s position, the baseline and
portfolio of the ICB estate. It detailed the current and projected
population and the known shortage of rooms for patient
appointments.
- Growth areas and priorities for
further work.
- Opportunities, including a
collaborative working approach.
Questions and comments were invited with
responses provided as indicated:
- The Stratford and Warwick District
Councils were producing a joint Local Plan for the South of
Warwickshire. Such plans included a ‘target’ number of
new dwellings, and one consideration was whether to extend existing
settlements, or development of new settlements. It was questioned
from a health perspective which option would be easier to plan more
reliable services for.
- Tim Sacks replied that there were
challenges both in terms of buildings and workforce with a need to
increase both, to improve access to services. The S106 funding
received was not sufficient to build new premises. Options were
expansion of existing premises within the funds available, or
providing a new premises which was reliant on an external funding
contribution to make up the shortfall, currently estimated to be
around 40%. The S106 funds were used to maximise existing
practices, but this meant no new premises were built due to the
capital finance challenges. Simon Doble added that S106 was
inflexible, which was frustrating. There was a commitment for the
ICB and WCC to work effectively with districts and boroughs. For
significant developments, Janet Neale touched on the potential for
developers being required to build the premises, rather than
negotiating a financial contribution.
- Local authorities were required to
provide a prescribed number of additional houses and for the
Warwick and Stratford areas this was some 39,000 homes in the next
10 years. It was questioned if the health sector made
representations to the Planning Inspectorate regarding development
allocations. There were real concerns about the impact of such
additional development on health services due to the lack of
sufficient funding to provide the services required.
- Janet Neale stated the need to work
together and inform the Local Plan process at an early stage. The
move from three CCGs to a single ICB and consistent approach was
helpful. Officers were trying to address the current position and
to inform future local plans at a very early stage, providing a
robust evidence base of service need. This evidence would inform
the Planning Inspector.
- Further points were made about the
timescales for completion and adoption of a local plan, that the
NHS was not speedy at dealing with such issues and developers
sought to avoid or reduce commitments through S106 agreements. The
member was very concerned at the impact for future health services.
The Chair wondered if officers were being put in an impossible
position. Officers reiterated the commitment between the ICB and
WCC. There were endeavours to collaborate with all councillors and
planning colleagues, to make this work.
- In North Warwickshire, the closure
of a Polesworth surgery required patients to transfer to Dordon. A
lack of public transport caused issues with some patients unable to
access this surgery. There was a satellite surgery in Polesworth
which was underused currently and could be more effective.
Residents voiced their frustrations to the local councillors. The
point was acknowledged. An audit was taking place of all 153
surgeries and their current utilisation. This included 33 branch
surgeries, which were not used on a full-time basis. Whilst it was
far more efficient to operate from a single premises, there was a
known shortage of estate. Part of the review would look at the
potential to make more use of underused premises. Workforce
shortages were raised, along with the public transport issues and
the projected population growth in both Polesworth and Dordon. A
written reply would be provided on the current utilisation of the
branch surgery in Polesworth.
- It was noted that some 4,500 new
homes were planned for the Polesworth and Dordon areas. A view that
another GP practice should be established to create
competition.
- Some people needed to use medical
services in neighbouring areas. This was acknowledged and for those
living close to a county boundary, typically 15-20% would use
services in neighbouring areas. Similarly, the S106 funding for new
developments would rest with the local area where the development
had taken place. There were regular discussions between adjacent
ICBs. It was evident that when people moved home into Warwickshire
they may stay with the previous GP and continue to use the same
pharmacy.
- Discussion about primary care
contracts. In some areas, alternative provider medical services
(APMS) contracts were used. Additional costs were often incurred,
alongside challenges for finding additional premises and issues
around continuity of care where there were shorter-term contracts. Securing the funding to
build a new premises was difficult so the driver was population
increase, not creating competition.
- A suggestion that planning law
needed to be changed so that a lack of GP services was a ground for
refusing an application. However, GPs were not a consultee to the
planning process. In the Stratford area, there was a high number of
care and nursing homes. This placed additional demands for GPs in
that area with the requirements for home visits reducing capacity.
The area had lost two surgeries and the remaining surgery was
struggling to cope with the service demand from 30,000 residents.
The Government should be lobbied on changing planning law.
- A member summarised the challenges
raised during the presentation, asking how they would be addressed
to balance supply and demand. Simon Doble replied that this was
more to do with access than estates. NHS England was undertaking a
project on primary care access recovery guidance. ICBs had been
asked to work with primary care in responding. Effectively this
would set out the overarching approach. It would lead to a roadmap
and then delivery plan to address known issues. Creating a modern
general practice, implementing changes and being innovative were
cited as examples. There was no capacity within budgets. Every
decision to fund something had to be offset by a corresponding
saving elsewhere, so using existing buildings rather than new
building and making more use of technology were further examples
quoted. There was not the funding to create more capacity though
extra buildings in every location. There needed to be different
ways of working, which were mutually agreed and making better use
of existing premises.
- Further discussion about the
Government’s proposal for an Infrastructure Levy to be
introduced as part of planning reforms. Another proposal was to
reduce the time period for the local plan process from typically 8
years to 30 months. Members were encouraged to be involved actively
in responding to these consultations.
- The relationship between estates and
workforce was raised by Chris Bain of HWW. A need to think about
timelines for recruitment and retention across both the NHS and the
care sector. This may provide an assurance for the population.
Points about population growth, having
regard to demographic data and that from the Joint Strategic Needs
Assessment (JSNA) too. On collaboration, this was seen as the way
forward. A need to engage with social care, the voluntary sector
and communities, as well as Healthwatch. The points raised were
acknowledged, with an outline given of the joint work with primary
care to match staff placements and available space. Collaboration
did need to include all sectors.
- Councillor Bell, Portfolio Holder
said the outcome of the NHS estate audit would be interesting to
see. She spoke of the challenges faced in securing a pharmacy for a
new health centre in Hartshill. It was questioned why this had
proved to be so difficult. Furthermore, pharmacies were private
businesses. There seemed to be a reluctance to create competition,
but additional pharmacies could offer extra support for GPs. It was
questioned what changes were proposed to improve internal processes
for delivery of GP surgeries. Where large developments like that at
Upper Lighthorne took place, people moved in, registered at
existing surgeries and placed additional demands on them, long
before the new surgery was available. It was important that the new
facilities were built at the right time.
- Similar concerns were raised for the
Kenilworth area, where 2,000 new homes would be built placing
demands on the two surgeries serving that area. The local member
would welcome a discussion outside the meeting. There was a
recently opened school and potential for a new community facility
to be provided as part of the development. It was questioned if one
of these could include a room for use as a GP surgery.
- Tim Sacks agreed to pick up the
points raised with the members. There was a need to be realistic as
‘outreach’ services were more costly in staff time when
compared to having multiple clinics in the same location. If
premises were of sufficient size, they effectively became a surgery
and did add value.
- For the Nuneaton area, points were
made about encouraging GPs to locate in areas of new development,
planning tensions and the regeneration planned for this area, which
may yield suitable premises for an additional surgery. It was
questioned what the ICB could do to encourage GPs to locate in new
or multi-use centres, or presently unused premises which could be
converted to be a surgery. Tim Sacks reiterated that whichever
building was used, the NHS still paid for it through a notional
rent. The ICB would look at each primary care network (PCN) area to
see what was needed and the potential to be innovative, whether it
required extension to an existing practice or an additional one.
The key was having a joint solution for each area, recognising the
financial constraints, and the growing population to ensure access
to services. He was not aware of GPs showing resistance to move
into premises.
The Chair closed the item, thanking the
presenters and members for their questions. Any follow up questions
from this item should be submitted to Democratic Services, in order
that a response could be requested.