In 2022, a record number of new houses were built in Midlothian, with a total of 822 completed in the year. As people moved into their new homes, local GP lists increased. Yet the council received no contributions towards health care facilities.
Now The Ferret has heard calls for primary health care infrastructure, including GP surgeries, to be considered at planning stages of all new housing developments with developers compelled to contribute towards costs.
Professional bodies including the British Medical Association (BMA) Scotland and the Royal College of General Practitioners (RCGP) in Scotland both said action on housing developments was needed in order to meet the crisis facing GPs head-on.
With planning and additional funds local healthcare services could employ additional locums and other healthcare workers, they said, as well as building new surgeries or expanding existing ones.
When developers build new houses in Scotland, they enter into agreements with the local authority that can oblige them to provide funding towards the expansion and development of related infrastructure like schools, roads and green spaces.
But while these can include spending on healthcare infrastructure, there is no legal requirement for them to do so — leaving GP capacity across Scotland outstripped by increasing demand.
This week, The Ferret revealed that patient lists in Scotland have doubled or even quadrupled over a three year period, with single GPs at more than 100 practices having more than 2,000 patients registered with them.
The Ferret’s analysis revealed that in Midlothian – where 8,000 new residents have moved in to developments since 2018 with a further 10,000 expected by 2028 – GP lists have been rising rapidly.
In December Danderhall Medical Practice revealed it was closing because GPs said they could no longer work safely. Its lists had increased by more than 40 percent over six years.
At the nearby Pathhead Medical Centre, where list sizes have increased by about 20 percent over a three year period, Dr Sigi Joseph said workloads were manageable by working long days of up to 12 hours.
She agreed action should be taken to ensure the impact on GPs was considered by developers.
“A lot of new people are moving into an area and of course they need a GP but there is no expansion of the service to meet that need,” she said. “Developers contribute to a new school, or a park if they are building over a certain number of houses, but they don’t contribute to GP services.”
She said GP surgeries found it difficult to recruit after the lists had already increased “because the job comes with so much pressure”, underlining the need for better planning.
Councils have powers over developers
Her comments were backed by the RCGP in Scotland. Joint chair Dr Chris Williams said the organisation had been calling for action for more than a decade.
“If this was done during the inception stage of planning, primary care services could be better deployed and more effectively integrated to the benefit of patients and communities,” he added.
Local authorities across the UK already have the powers to demand funding for GP surgeries as a condition of building, but are under no obligation to use them in this way or at all.
In England and Wales, these powers take the form of a section 106 agreement made between a local authority and developer to address impacts on infrastructure, or a community infrastructure levy, which works in a similar way.
These powers are most often used to fund other public infrastructure such as transport and education. But in some cases funding has been put towards GP practices including the Over Surgery in Cambridgeshire, which received £90,000 from housing developers in June 2022 to build new examination rooms.
Earlier this month, plans were submitted to Broadland District Council in Norwich to extend an existing GP practice onto land owned by developer Hopkins Homes and transferred to the council through a section 106 agreement.
However, an 2018 investigation by GP magazine Pulse found that, of £61.5m of funding collected from housing developers in England through the community infrastructure levy over three years, none was spent on GP practices because the legislation does not specifically ring-fence money for that purpose.
A 2020 report by the think tank Reform found that the NHS was missing out on millions of pounds worth of section 106 funding because Clinical Commissioning Groups did not have a clear understanding of how it should be spent.
Meanwhile in Scotland, the corresponding power is a section 75 agreement. But a 2021 report on developer contributions in Scotland found that while the funding of healthcare infrastructure is permitted within the legislation, requests for such contributions were rare and not clearly understood.
The British Medical Association told The Ferret that the Scottish Government, councils, health boards and developers should work together to ensure the need for increased GPs infrastructure considered in planning stages.
“It becomes simply unsustainable for primary care if planning for new housing developments does not take into consideration the health care resources available in the area,” Dr Patricia Moultrie, deputy chair of the BMA’s Scottish GP committee, told The Ferret.
“We need immediate action…to ensure that new practices are built and staffed in areas with high levels of residential construction in order to provide the public with the GP services they need and deserve.”
A Midlothian Council spokesman said: “Councils don’t have any responsibility for GP practices and Midlothian Council already charges developers higher than average percentages. We use that money to build supporting infrastructure like schools, roads and other community facilities.”
A Scottish Government spokesperson said that “infrastructure requirements” should be “clearly identified and evidenced by authorities early in the planning process”
They added: “Councils can already seek healthcare contributions using existing mechanisms, such as section 75 planning obligations. It is for them to determine how much to seek from developers, taking account of the specific impacts of a proposed development and relevant planning policies, and to allocate that money according to local needs.”
Cover image thanks to monkeybusinessimages/iStock
GPs in Crisis is an investigation by The Ferret examining the pressure on doctors and patients at the frontline of community healthcare. Support our journalism by becoming a member for £5 a month at theferret.scot/subscribe.
This story is part of our Health Gap project, funded by the European Journalism Centre, through the Solutions Journalism Accelerator. The fund is supported by the Bill & Melinda Gates Foundation.