PARLIAMENTARY DEBATE
General Practice: Large Housing Developments - 29 March 2022 (Commons/Westminster Hall)

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.

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.

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.

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.

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.

It is always a pleasure to speak in a debate in Westminster Hall, and today I basically support what the hon. Member for South West Bedfordshire (Andrew Selous) has put forward. I always give the perspective from Northern Ireland. What is happening there mirrors what the hon. Gentleman has introduced, and I thank him for setting the scene so well.

Access to GPs would probably make a debate on its own. I think we could all give myriad examples of where the system is failing. I know that Northern Ireland is not the responsibility of the Minister, but I want to add weight to what the hon. Member for South West Bedfordshire said. I am convinced that others, including the shadow Minister, will also mirror that. We could all speak for ages about access to GPs, but I will fight the urge to spend my time discussing the disgraceful routine that too many practices have adopted of withholding face-to-face appointments, and the problems caused, including with house calls to vulnerable patients.

One of my constituents, who uses a wheelchair, was the only family member to have covid. Her carers and the district nurse expressed concern about sores on her legs, because she is a type 1 diabetic. Her GP refused the call-out and asked an 80-year-old woman to WhatsApp a photograph. My goodness, how ridiculous! Not to be disrespectful, but the lady has no idea what a WhatsApp photograph is or how to take one. That says more about the GP, who has not understood the issues. It seems I did not resist the urge well, but I remain infuriated at the abject dereliction of duty that GP practices continue to hold fast to. That was one example, but many other GPs, as referred to by the hon. Member for South West Bedfordshire, do it right and do their best to help people, as they should.

I will not say any more about that at this stage, because it is not the purpose of this debate. I want to talk about the other part of the debate, which we need to take steps to address. We need to ensure that enough thought is put into not simply whether the roads can handle the additional pressure from large-scale housing developments but whether community GPs and pharmacies can handle it as well.

My GP cannot take another patient without expanding. I have been with that practice for all my life. It has expanded once and will expand again—a planning application is pending—within its property because there is room to do that. It is not the same in every case, but we need flexibility for that in the planning process. To back up what the hon. Gentleman said, I will give an example of where the process fails badly—I know that my area is not the Minister’s responsibility—and there does not seem to be any vision or idea of how to do it the right way.

I live in a village between Greyabbey and Kircubbin and patient numbers in the GP surgeries in Kircubbin are growing, so an extension has been accepted by the trust and will go ahead. There is money to invest in that surgery as well. I know that is not the Minister’s responsibility, but this ties in with what the hon. Gentleman said: we need funding from the Minister’s sister Department in Northern Ireland, the Department of Health, to ensure that moneys are there to help with those extensions.

A local doctor’s surgery in Newtownards has a wonderful idea, similar to that described by the hon. Gentleman and what he wants to see for his constituency. It is currently based above a pharmacy, and its vision is to expand. It put in an application to build a further three rooms for a physiotherapist, a nutritionist and a mental health nurse so that, when someone goes to their clinic to see their GP, they can do almost everything. That would take the pressure off the NHS—or the HSC as it is in Northern Ireland. It is important to have a strategy in place. I was incredibly impressed by that vision and drive for my constituency, which is like the vision to which the hon. Gentleman referred. That could address the needs of the adolescent having difficulty with their relationship with food, the needs of the grieving widower by giving them something other than anti-depressants and making sure that they always have a face-to-face consultation, and the needs of the overweight working mother who needs an adaptive plan to help her achieve her goals in her busy life. That is not a criticism but a fact of life—it happens sometimes. However, the planners turned the application down.

The planners did not have the vision or the strategy to see how important it was to have a better surgery and a better clinic, so a project that could provide a benefit was turned down. Where is the planners’ vision? Where is the co-operation between the health departments and the housing and planning departments? I do not see that in this application and I feel greatly aggrieved. I will fight the issue—I intend to take it as far as I can, along with others—because it infuriates me. The planners look at it as a tick-box exercise and think, “It doesn’t do this and it doesn’t do that,” and yet this is the place for the project. There is room to do it on site, so why not let it take place?

The choice for the GP service is to move out of town or simply to carry on as it is, which will not meet the needs of the practice, with the growing numbers coming. We need fully serviced practices and must be able to host them. We must also ensure that large-scale developments recognise that integral need of the community and address this issue. It is no longer enough to tick the box and build a play park when people need access to GPs in their areas. To continue to ignore that will only move concerns down the line.

I see the Minister in his place and know that he is consistently interested and committed to the change that the hon. Gentleman is asking for and that others will ask for. I am confident that he will respond positively—he always does, as that is in his very nature—so I will be pleased to hear his response.

On 2 November 2021, the Secretary of State for Health and Social Care acknowledged that the Government were not on track to meet their plans to recruit an additional 6,000 GPs by 2024—that is not a criticism but an observation of his comments—and the Government had a manifesto commitment to expand the number of other primary care professionals by 26,000. How can we entice young people to be doctors when they go for work experience in poky offices and are inundated with unsafe patient numbers, and when GPs tell them to run? The right hon. Member for Chipping Barnet (Theresa Villiers) referred to that and to some of the issues.

That situation will only continue, and the Minister can respond in a positive fashion only if he has co-operation from the Health Department to make things happen; we need a two-pronged attack on this one. Do we, as I would like to see and as the hon. Member for South West Bedfordshire said, invest in practices now and entice medical students into seeing that the dream of holistic general practice is a reality? That vision of a future in which we can do better and look after more people in a focused way is what I would like to see and what I think everybody else wants to see as well.

Having specifically designed facilities is key to that aim. That is why the application in Newtownards addresses a number of things, which are all part of what comes to a GP every day. That GP surgery and clinic is in the centre of Newtownards. It is accessible; there is car parking. It is right in the middle of the town. It makes more sense to let it do what it wants to do within the room that it has on site, but the planners do not want that to happen. There is no vision, no strategy, no co-operation with the Health Department and no helping to address the issue.

Therefore I find myself fully supporting the hon. Member for South West Bedfordshire, and I implore the Minister to make this initiative—although it is not his responsibility—UK-wide. What starts here can ripple out, like when a stone hits water, and when it gets to Scotland, Wales and Northern Ireland, we can have some vision as well. I will send a copy of the Hansard record of this debate to the planning department in Newtownards and make it aware of my plea on behalf of the GP surgery there. Planners and healthcare commissioning groups alike should be legally obligated to abide by this initiative. They should have a strategy, a vision, and do it right. The future of our NHS depends on change, and this change is fit for every area. We must move on this need now, before the implosion of general practice that is on the horizon and becoming ever clearer.

I again thank the hon. Member for South West Bedfordshire. I look forward very much to other contributions and I look forward especially to hearing what the Minister has to say.

Order. We have seven more Back-Bench speakers. We will start the winding-up speeches no later than 10.38 am to give Mr Selous time for a two-minute response. There is no formal imposition of a time limit, but if colleagues could keep to about six minutes maximum, that would be best.

It is a pleasure to serve under your chairmanship, Mr Dowd. I pay tribute to my hon. Friend the Member for South West Bedfordshire (Andrew Selous) for securing a debate on this important issue this morning.

The Mayor of London wants 2,364 new flats and houses to be built in the borough of Barnet every year for years to come. I did a rough calculation for some of the bigger developments recently built, approved or pending in the planning system in my constituency alone, and the figure is nearly 4,000 units, with another 691 rejected but liable to come back on appeal or possibly with a revised proposal. That could mean anything up to about 9,000 people trying to find a place on a GP’s list of patients. I pay tribute to all the GPs in my constituency. They are the bedrock of our NHS. We all depend on them, and they have done magnificently in so many ways during the pandemic.

It is clear that rising healthcare need is already placing great pressure on our national health service, including general practice, as we grow older as a society and as our frail elderly population gets larger. But at the same time, council planning committees are finding it harder and harder to turn down planning applications even where it is clear that the area does not have the GP capacity to service the population increase that the proposed new flats could involve. Elected councillors are increasingly advised by officers that they should not turn down an application even if it contravenes long-established planning principles on matters such as character, conservation, height, density or pressure on local services and infrastructure, because their decision could be overturned on appeal, on the grounds that housing targets are not being met. To compound the pressure, elected representatives are threatened with high costs being awarded against councils if they lose planning appeals. That is forcing councils to produce long lists of development sites to meet the requirement of a five-year land supply, many of which may be wholly inappropriate for new housing—certainly high-density new housing. Even where developers offer to build facilities for a new GP practice as part of their plan, that does not solve the problem, as I said to my hon. Friend the Member for South West Bedfordshire, because it is a shortage of doctors, not premises, that is causing the greatest pressure on primary care.

My hon. Friend clearly articulated a solution in his speech, but I would like the Minister to consider a threefold solution. First, housing targets should be advisory, not mandatory. They should not be taken into account in planning decisions or appeals. Secondly, whether or not a local authority has a five-year land supply should no longer determine planning applications. Thirdly, we need to accelerate efforts to train, recruit and retain more family doctors. The Government take the expansion of the NHS workforce very seriously, and it is a proud achievement that there are more doctors in hospitals than ever before in the long history of our national health service. The Government have ensured that there are more GPs in training than ever before, and five new medical schools have opened. That good progress is all welcome, but as the Health Secretary has admitted, plans to recruit 6,000 additional GPs by 2024 are not on track. We need to turn that situation around if we are to tackle the covid backlog and ensure that, where new homes are built, all residents—existing ones and new ones—continue to be able to access the GP appointments they need.

I hope the Minister will set out the care improvements delivered by the £250 million package announced last year to relieve immediate pressures on GP practice. I hope he will also give us the latest numbers on the recruitment of other professionals, such as nurses and pharmacists, to support GPs as part of multidisciplinary practices. Will he commit the Government to redoubling their efforts to plan effectively for the future workforce needs of our national health service?

Thank you for your remarks and for keeping within the advisory time limit.

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing a very popular debate. I declare that I am still a borough councillor for Charnwood Borough Council, which I will refer to. I am also the chair of the all-party parliamentary group for district councils.

As the Minister can see, he has many friends on the Government Benches, but we suffer some frustrations, and I look to him for advice and assistance. We have two main frustrations: one he can clearly do something about, and the other we need his help with in tackling it with the Department for Health and Social Care. We have GP contracts and the related health profile, and we have planning law—and never the twain shall meet, it would seem. I would like to do something about that.

I would like to be able to support housing developments where they are appropriate and needed and of the size and type required for the local area. More importantly, I want local communities to be created. Three thousand houses in one place is a village, not a housing estate, and I would like to create communities with proper infrastructure. I would also like to support my GPs and constituents. I have had many meetings with GPs in my constituency over recent months. They have worked incredibly hard, particularly during covid. We talk about going to see “our GP” an awful lot, rather than going to see a medical professional in a medical centre, perhaps run by a GP. There is something that needs to be done there.

In my constituency, I could talk about the village of Sileby, which has grown hugely, or about Loughborough or Mountsorrel, but I will talk about Shepshed and west Loughborough. The town of Shepshed has grown enormously over recent years, with the addition of thousands of houses. In the Garendon estate, right next door in west Loughborough, 3,000 homes are due to be built. There are two GP surgeries in the whole area and so, whatever they try to do, the situation is completely unsustainable.

I have talked to the clinical commissioning group and the local health service. Everybody is keen to do something, but there is a definite reluctance, because of the risk factor. There is less incentive to run a GP surgery than to just work in one or be a locum; there is a lot of risk involved. We need to take that into account; we need to consider the cost and the risk of extending a GP surgery or starting a new one.

My right hon. Friend the Member for Chipping Barnet (Theresa Villiers) spoke about the lack of a five-year housing land supply. That is absolutely crippling my constituency. We need to stop indiscriminate development that has no forward planning. Planning staff in the council work hard on local plans—they are looking forward to 2036—and on delivery, but without a five-year land supply, it is impossible. The intentions are good but in practice we are not delivering in Loughborough.

The Conservative manifesto stated:

“Infrastructure first: We will amend planning rules so that the infrastructure—roads, schools, GP surgeries—comes before people move into new homes.”

We must do that. The housing infrastructure fund has not created the atmosphere and the momentum we were expecting. I would like to see more.

I agree with my hon. Friend the Member for South West Bedfordshire on the recommendation as regards the number of patients per GP. I also ask the Minister to consider age profiles. The people who live in the Shepshed area have an older age profile and, generally speaking, older patients need GP surgeries more.

We need cultural change—a shift towards seeing a nurse or another professional in a medical centre, not necessarily having a face-to-face appointment with a GP. We absolutely must start five-year land supply. I would also like to see feasibility studies and infrastructure funded up front, either by the developer or through the fund, so that feasibility studies of GP surgeries do not require GPs to stump up the money first.

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing the debate. He and I got talking a few weeks ago because I asked a question at Prime Minister’s questions too. In it, I gave some figures about the growth in my constituency. The largest town, Didcot, is set to be 42% larger in 2027 than it was just a decade earlier. Wantage and Grove, the second largest area, is set to be 59% larger than it was just a decade earlier. Thousands of houses are also being built in the other two towns, Faringdon and Wallingford, and in the 64 villages I represent. My hon. Friend and I decided we would be better combining forces and working with other colleagues, as the issues we face are similar.

People know what the growth figures mean: it is harder and harder to get a GP appointment. It is a separate issue to the post-covid debate on face-to-face, telephone appointments or an e-consultation. This issue is much longer running. It is also distinct from the 6,000 GPs and 26,000 other primary care staff that the Government have committed to recruiting, which I warmly welcome.

It should go without saying—although I will say it anyway—that our GPs and primary care staff work incredibly hard. They want a solution to the problem as much as anybody else, because they are working flat out and are presented with more and more patients. I have a surgery in Wallingford that actually closed its books recently because it simply cannot take any more patients.

Depending on what measure we look at, different parts of my constituency look the worst, but Didcot ranks lowest on the measure of permanent qualified GPs. Didcot is a good example, because we have had a development there called Great Western Park, which is 3,500 houses. On the basis that 2.4 people live in every house, 8,400 people have been added to the constituency, and they have now been waiting seven years for the GP surgery that was promised with the development. There is still no sign of it, but what they do know is coming is Valley Park right next to them—4,200 more houses, and a further 9,600 people. That is 18,000 people just in those two developments, but there is no prospect at the moment of additional GP surgeries.

Who is accountable? Part of the problem is that it is very unclear. Many people think it must be the Government, and of course it is partly down to the Government and the rules for infrastructure not keeping up with house building. As hon. Members have said, there is a difference between what the Department of Health and Social Care, the Department for Levelling Up, Housing and Communities and the Treasury want. Of course that is true, but the provision of GP surgeries is also down to councils and what they do with the section 106 money and community infrastructure levy that they are given. It is also down to the developers and the promises they make, the CCGs and how they plan for things, and the national planning bodies such as NHS England and Health Education England. Part of the problem is that there is no directly responsible body that can ensure that people get the services they need.

There is no shortage of people wanting to be medical students. I used to work in social mobility, and studying medicine is one of the most popular things that young people want to do. The issue is partly the diversity of the people who get into it: only 6% of doctors are from a working-class background, and someone is 24 times more likely to be a doctor if a parent is a doctor. I cannot help but feel that we are missing out on a talent pool of people who want to be doctors, yet we do not have enough GPs.

A number of Members have made important points about the things we need to do. Of course, it is not just about GPs. Lots of things I campaign on are about infrastructure—reopening Grove station, improving the A420 and A34, having more school places and so on—but there are three things that I would draw attention to. First, we need the infrastructure before the houses go in. In this case, that means knowing precisely who will run the GP surgery and having them signed up with the contract to do so before we start. We recognise that most GP surgeries are private businesses. It should not be as difficult as it is to get somebody committed and to know what we will do with the money.

The second point is that I am not persuaded that we should not have a limit on the number of patients that a GP or practice should have. It would be extraordinary in other fields if we did not have a limit on the number of people that we thought was suitable. I totally accept that areas are very different, but surely we can have an upper limit that triggers additional services once it has been reached or exceeded, as it clearly has been in my constituency.

The third point is about the talent pool. We have shortages of all sorts of things in this country, but a lot of people want to study medicine and we are not using them. We could be much better at recruiting people.

We will not solve this problem today, and I look forward to hearing what the Minister has to say, but if we want people to not feel that houses are a curse on their local area, they need to know that their quality of life will not decline. That means putting in the right infrastructure, particularly GP surgeries.

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my county colleague and hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing the debate. He will know that this is a particular issue for Bedfordshire.

In my own constituency over the course of the last decade, the town of Biggleswade, the village of Stotfold and the newly parished area of Fairfield Park have been dramatically transformed by housing growth. In many instances, that has created very welcome, happy communities and neighbourhoods for people, which have grown and become a natural part of the environment; but we cannot ignore the pace of growth and the impact that it has had on those residents new to the area, and on the existing residents who have accepted the additional growth in their areas.

Two issues make for happy communities. First, is the pace of growth sustainable and are the services there that people come to expect from the Government, in terms of school places and, as we are discussing today, of GPs?

My constituency is growing at a rate of about five times the national average. Between 2015 and 2020, the population of this country grew by about 1.9 million people. If all constituencies grew at the same pace as mine, there would be over 5 million new people in this country. I ask the Minister, when it comes to housing, could we please consider an absolute cap on what local communities are expected to have in any long period of time? If we do not have that pressure against market forces, I fear that we are building some concerns for the future.

I know that Conservative colleagues—replete in their number here today—have a large number of questions about planning reforms. I would just say this to the Minister. The previous Secretary of State focused, I think rightly, on the efficiency of the process of planning: how do we get more houses built? That is important. Will the Minister also focus on how effective the planning is for the communities where those houses are built? If we have that slight nuance in the approach on planning, I think that would be helpful.

Of course, I come today not to bury the Minister, but to praise him; because he knows that his colleague in, I think, June 2021, in response to a debate that I called on housing growth in my constituency, killed the 1 million housing target that was in the Labour peer Lord Adonis’s housing target for the Ox-Cam arc. The Minister also knows that his Department, under the new Secretary of State, has said that it wishes to de-emphasise—to flush away—the Ox-Cam arc, which Lord Adonis, the Labour peer, was using as his Trojan horse to build a million houses in the play spaces of Buckinghamshire, Bedfordshire and Cambridgeshire. It is welcome that those changes were made, so I want to put on record my thanks to the Minister and ask him to make sure that we follow through to ensure that unreasonable targets are not placed on councils in the Ox-Cam arc area.

The Minister also knows that his colleague said that he would arrange meetings for me with the Department for Education for school places and with the Department of Health and Social Care on GP places. I am grateful to the Department for allowing that meeting to take place with school places; we had a very good meeting with the Department for Education, but I am interested to learn more from the NHS. I am completing a survey of GPs and around June this year will have the opportunity to present a report. Will the Minister follow up on that with his colleagues in the Department of Health and Social Care to ensure that I get access to the Secretary of State when that report is ready?

I just want to make a couple of points on GPs, if I may. As many colleagues have said, I know that people are frustrated that they cannot get access, but they should know that their GPs are working very hard. I would make this point: abuse is never acceptable when people contact their GP surgery. People should hold back. Don’t go all Will Smith, right?—don’t go all Will Smith when you call your GP surgery. Make sure you take that extra breath when you talk, because the people you are talking to are under considerable pressure.

We need to look at the GP partner model. I know there are many who would like to say that that model is an oddity in the new world. No, it is not. Entrepreneurship and the idea of running your own business has its place in primary care. We need to make sure that we open up and broaden the way in which we give people access to primary care. We have to recognise that GP access is a bottleneck in the system. I fully support infrastructure first, but the answer is not always more people. Often, it is more efficient processes with the existing people, or new avenues for people to access the care.

Will the Minister go back to his colleagues, as he considers GP practice and housing growth, and say, “Please make more progress on giving people the power to understand how they can access primary care”? We are making good progress with the NHS app, but it is an NHS app designed for us that actually looks like it was designed for doctors; it is very hard to make effective consumer decisions using the app. I ask the Minister to broaden the access for people to get into primary care through chemists and other facilities, and to please move forward with diagnostic centres.

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this important debate. The provision for affordable housing and access to good healthcare are among the top issues raised with me by constituents in Truro and Falmouth in Cornwall. Those issues must be tackled in conjunction. I thank all the GPs and primary healthcare professionals in my constituency who have been working so hard over the last few years—as they always do.

I recognise people’s concern about the impact of large-scale developments on local services. That is why we must increase the provision of affordable housing while keeping in mind that for local communities to accept the new housing developments, new developments must be supported by health infrastructure. In the right place, large-scale developments can not only ease the housing crisis but act as a catalyst for reforming and tackling health issues and inequalities. We need to ensure that large developments can provide those opportunities.

Primary care delivery always requires funding, a physical site and willing providers. Those providers are GPs, which are generally private businesses and differ in their capacity. They will also differ in the demographic that they serve. Large-scale developments should be able to assist with that funding, and we must continue to ensure that local planning authorities can enforce that through mechanisms such as section 106 and the community infrastructure levy. I am pleased the Government have committed to further reform in that area, including proposals in the levelling-up White Paper for a new infrastructure levy that will enable local authorities to capture value from development much more efficiently. However, I echo the call of others that co-ordination with the Department of Health and Social Care is an utterly sensible way forward.

Developers can also provide physical sites by reserving land to deliver health services. I am pleased that developers for the controversial Langarth Garden Village in my constituency, which will eventually provide up to 10,000 new homes, are committed to doing the right thing and have secured, through the planning system and with the council’s involvement, permission to develop a new health infrastructure. I would like to thank, since he is in the Chamber, my right hon. Friend the Member for South Staffordshire (Sir Gavin Williamson) for providing a new free school on the north coast of Cornwall that will, in part, deliver school places for that very controversial new estate in my constituency.

The health infrastructure plans include a new health and wellbeing centre embedded in the Langarth community, a state-of-the-art health hub to provide a one-stop shop that includes GPs and primary care treatment as well as other health facilities that have been mentioned today, such as a dentists, a pharmacy and diagnostic services to reduce pressure on existing local services. However, it is important that we remember that GPs are a private business, and as such the Government must create the right conditions to ensure they can supply and maintain that service.

In Cornwall we have a housing crisis and a health and social care crisis. We have mentioned today that solutions to the two crises come together—one absolutely affects the other. GP surgeries in Cornwall frequently report that they are short-staffed; they have offered jobs across the entire health service in Cornwall, but people cannot take the work because they cannot find housing. That applies to any kind of healthcare worker, right up to consultant level, but certainly applies to GPs and dentists. We must ensure that key workers from both the public and private sectors can buy and rent affordably in the area. I would like more key worker housing to be set aside in the Langarth development.

Key workers are vital, but they tend to earn less than the national average, have fewer assets and have more limited choices about where they can work. That means that they find it harder to get on to the property ladder or to rent decent homes close to where they need to work. It is worth mentioning that the Langarth development is very close to our hospital. I would also like to see more one-level, one-front-door properties in the development for our growing elderly population. Let us create communities where they need to be. I am pleased that the Government have already taken several steps to ensure that we meet the needs of key workers in local communities, including the 30% discount under the First Homes scheme or the assistance available under Help to Buy. However, even with those schemes in place, many key workers struggle to get on the housing ladder, and there is a huge shortage in Cornwall.

There are various options available to the Government; I will mention a few. In areas with key worker staff shortages, local authorities and housing associations should consider giving greater priority to local key workers in their respective allocations and lettings policies. In addition, the Government’s future affordable housing funding programmes should prioritise allocating grant funding to affordable housing schemes in which a significant proportion of homes are reserved for key workers. It is especially relevant to places such as Cornwall, where we are on a peninsula and cannot borrow key workers from other local authorities.

It is clear that new housing developments must be supported by the appropriate health infrastructure. Developers can help to provide funding for sites, but GPs and other health providers supply the service and we must do more to ensure that those workers can afford to buy or rent near their place of work.

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank my hon. Friend the Member for South West Bedfordshire (Andrew Selous) for securing this really important debate.

Being able to access GP services is an incredibly important issue for my constituents. In fact, I receive almost as much correspondence on that issue as I do any other topic, and my constituents have expressed a real frustration with the difficulty of being able to secure a local appointment with their GP, as well as not being able to see their GP face to face as much as they would like. I appreciate that this is no fault of the GPs themselves, and I would like to put on record my thanks and pay tribute to all the GPs across my constituency, who have done an extraordinary job over the past 24 months—and indeed also worked incredibly hard before that, and continue to do so.

I recently met some GPs from the Modality Partnership, who told me that much more needs to be done if we are to deliver the level and provision of service that the public so desperately want. It is clear that approving large-scale housing developments will only make the problems worse, when we allow the housing developments to take place with no thought to increasing healthcare services by providing physical facilities and revenue expenditure for employing and recruiting more GPs. That is currently a big concern for many of my constituents, right across Keighley and Ilkley.

Only last year, the Labour-run Bradford Council proposed in its draft local plan to increase the number of houses to be built right across my community by 3,000. That includes 314 new houses in Ilkley and Ben Rhydding; 181 new houses in Addingham; 188 houses in Steeton and Eastburn; 191 houses in Riddlesden; and 204 houses in Haworth and Cross Roads—I could go on. In the context of this debate, those proposals will have a damaging impact on the numerous GP services and facilities that many constituents are still finding it very difficult to access.

We can look at Long Lee, a small community on the outskirts of Keighley, where Bradford Council proposes in its local plan to build an extra 236 new houses. That will have an extra damaging impact on the local GP practice, which is already at capacity. Luckily, a recent housing application for that area was postponed; I can only hope that local healthcare provision will be a vital consideration when that housing application is put forward to the committee again.

In Silsden, the town is currently facing many housing developments, including from Barratt Homes, Linden Homes, Skipton Properties, and Countrywide, with an application that has recently been put forward. More recently, a 140-unit proposal has been put forward by Persimmon Homes, which is a live application. The town is being inundated and services just cannot cope. The town is being asked to put up with too many houses when the local healthcare provision cannot cope as it is already at capacity. It is completely wrong, and something must be done.

I commend the work being done by Silsden’s District Councillor Rebecca Whitaker, who is leading the fight against these proposals and standing up for our local services. I am supportive of the work being done by my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who has, as the Chair of the Health and Social Care Committee, launched an inquiry into local GP provision. I wholeheartedly hope that that inquiry looks at how we can make sure that expenditure is put into both capital and revenue in order to get better facilities put in place, and also that recruitment for GPs and GP services is given as much emphasis as possible.

My hon. Friend the Member for South West Bedfordshire made the important point that when planning applications are being considered, local healthcare service providers should have a statutory duty and responsibility to have a say in those applications, so that we can ensure that capacity is delivered for healthcare at a local level. When local authorities put forward their draft local plan, there should be an onus on them to have at least a conversation, but also to explore the facts about where capacity lies beforehand. In my area, when Bradford Council put forward their draft local plan last year, it had not even looked at the capacity available within local healthcare facilities. That cannot be acceptable.

Like my hon. Friend the Member for Wantage (David Johnston), I make the point about where accountability sits and whether it lies with the Government, local authorities, GP services, local communities or housing developers when applications come forward. In summary, it is vital that we acknowledge these issues, as we cannot continue this endless cycle of allowing large-scale housing developments or additional housing to be built in small communities, producing a dramatic impact, without any acknowledgment of general practice capacity.

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for South West Bedfordshire (Andrew Selous) on securing this incredibly important debate. The debate brings together two of the biggest categories of complaints that I receive in my constituency: housing development and GP services.

The town of Aylesbury has been expanding for more than 50 years. Indeed, the area of Bedgrove, where my parents had their first home together and where they took me home as their newborn son, more than 50 years ago, was built on the site of a farm, and many more farms and green spaces have been subsumed by housing developments in the ensuing half century—Walton Court in the 1970s, Quarrendon and Watermead in the 1980s and Fairford Leys in the 1990s and early 2000s. All have attracted many more people to make their homes in the proud county town of Buckinghamshire. With each new development, new pressures have been placed on existing communities and the infrastructure that serves them. Key among those services is the provision of healthcare, especially GP surgeries.

I want to be clear that neither I nor my constituents are opposed to development. We recognise that the next generation needs somewhere to live, and Aylesbury is a fine place to choose. However, since 2000, more than 16,000 homes have been added to the town. The newly approved local plan will add that same number again. The people who come to live in those new homes need excellent local services. They need road and rail connections, such as the Aylesbury link road and the Aylesbury spur. They need schools with enough spaces for all the children living locally. Crucially, they need sufficient healthcare provision, particularly at primary level. Yet GP surgeries in my constituency are already at breaking point.

Like other hon. Members present, one of the most familiar refrains I hear from residents is that they simply cannot get an appointment to see their doctor. In recent months, I have visited several GP surgeries not only to thank the hardworking doctors, nurses and, crucially, receptionists for their incredible work during the pandemic, but to hear first hand about the challenges they are experiencing. Top of their list is that there is simply not enough capacity to deal with all the patients who need care.

Meadowcroft surgery is a good example of the pressures that population growth can have on towns like Aylesbury. The surgery opened in 1964 to serve what was then the new Quarrendon estate. It moved to a new site at Jackson Road in 1992, with 8,000 patients on the list. Today that list stands at more than 16,000, and will grow to more than 26,000 when the surgery moves to another new site in Paradise Orchard later this year, following a merger.

For more than a decade, residents in the south of Aylesbury in Stoke Mandeville and Weston Turville have been opposed to a new development on a greenfield site called Hampden Fields. The Hampden Fields Action Group is extremely concerned that the development will have inadequate healthcare provision. Their fears are completely understandable, given that another area—Kingsbrook—is yet to have a new surgery 10 years after its construction.

It is just plain common sense that new housing developments need to include healthcare provision. GP surgeries and all that they now include—such as paramedics, pharmacists and, of course, nurses—are absolutely critical to that provision. We must ensure that buildings for these facilities are core to the design and planning of large-scale new housing developments, and we must also remember that we do not just need the premises; we need the people as well. So we need to ensure that we have enough young people training to join the health service across the full range of its professions, with courses such as those at Buckinghamshire New University, Buckinghamshire College Group and Buckinghamshire University Technical College all providing that critical first step.

We must consider retention as well as recruitment, so that people living in those housing developments will still have excellent healthcare provision in 10, 20 and 30 years’ time. And we must not forget that primary healthcare can result in referral to secondary healthcare. GPs send some of their patients to hospital, and that route must not be neglected either, when we consider housing development on a scale such as we are seeing in Aylesbury.

It cannot be left to a random soup of acronyms— section 106, CIL and HIF—to make all of that necessary provision. What we need is a strategic, considered plan that can be delivered fairly and transparently. And within that plan, we probably need to consider novel ways of financing infrastructure, so that we get it at a much earlier stage—before all the houses are sold and when the developers are prepared to pay.

Today’s debate is an important and welcome opportunity to highlight how crucial healthcare is to the British people as we tackle the burgeoning demand for new homes. I hope that the Minister’s response will serve to reassure existing and future residents of Aylesbury that the Government understand the challenge and are set to meet it head-on.

It is a pleasure to serve with you in the Chair, Mr Dowd.

I genuinely think that this has been a valuable debate about an important issue. I congratulate the hon. Member for South West Bedfordshire (Andrew Selous) on securing it and on the typically clear and powerful remarks he made in opening it. He has been raising concerns about this issue for a considerable period, and the fact that he felt compelled to secure this debate today only serves, I am afraid to say, to highlight the startling lack of progress on the part of the Government in addressing those concerns.

The concerns are not the hon. Gentleman’s alone; indeed, this issue is not confined to his corner of Bedfordshire. His concerns are widely shared across the House. As the attendance for today’s debate makes clear, they are keenly felt among Government Members in particular. I thank all the Members who have contributed this morning.

Having heard today’s contributions, we can only hope that the Minister will at least be convinced of the need to go away and revisit the fundamental aspects of a planning system that routinely fails to produce the necessary social infrastructure for new communities to thrive. We have heard lots of complaints and points of contention today, but it is within the Government’s gift to take action on many of the issues that have been raised. I hope that the Minister will go away with renewed vigour to address them.

The focus of this morning’s debate has been on the provision of primary care services for large-scale housing developments. I add my praise to the general expressions of support that have been conveyed today to GPs and GP practice staff. That we face significant challenges as a country when it comes to primary care capacity is not in dispute. The reasons for that shortage are complex, and when it comes to problems such as the recruitment and retention of enough GPs to accommodate rising patient demand or how local health services plan for population growth in service provision, those are obviously the responsibility of the Department of Health and Social Care. However, there is no question in my mind but that the planning system is exacerbating the crisis in primary care, particularly in areas experiencing significant development, by failing to deliver new facilities in places where the needs of large-scale new communities cannot be met simply by the expansion of existing sites.

The particular concern of the hon. Member for South West Bedfordshire and others who have spoken this morning is general practice capacity, but the national failure to ensure that all new large-scale housing developments have adequate primary care provision is mirrored in other forms of infrastructure, whether that be school places or transport, as the hon. Members for Wantage (David Johnston), for North East Bedfordshire (Richard Fuller), for Aylesbury (Rob Butler) and others have remarked upon. Having that infrastructure is absolutely key to gaining local consent, which is an essential part of the planning process.

I do not think that this issue is primarily one of housing supply. There is a housing crisis and we need to address it, but the crux of this issue is the need for up-front infrastructure investment before or at the point that a large-scale residential development completes and new residents move in. However, the planning system as it currently operates—and I think Conservative Members will accept this—is simply not geared up to facilitate that infrastructure-first approach on all major sites; all too often, no one has overall responsibility for place-making.

The importance of master developers was clearly identified in the Letwin review: they strategically assemble land, secure the necessary permissions, co-ordinate the delivery of the infrastructure and de-risk the development process as a matter of course. Without those developers, the system incentivises volume house builders to build often poor-quality housing in inappropriate and often entirely car-dependent locations, in a way that frequently leads to intractable disputes about how core infrastructure and services will be delivered and who will pay for them. Ultimately, the fact that the planning system lacks many of the features necessary to support effective large-scale housing growth stems from the failure of central Government to take a clear strategic role in the delivery of new large-scale communities.

The hon. Member for South West Bedfordshire and others drew attention to the inadequacies of the housing infrastructure fund, and they were right to do so. The fund can and does support the delivery of infrastructure on sites where viability is an issue and address the need for up-front infrastructure and the problem of risk on a limited number of sites. However, because it distributes funding on a competitive, ad hoc basis, it is not a general solution for the infrastructure needs of all large-scale housing developments.

Homes England could play a far larger role in providing local authorities with support and assisting local partners directly with delivery, land acquisition and the master developer role. It has extensive legal powers that allow it to take on that role and obtain land by means of compulsory purchase. It could be the instrument the Government use to support large-scale growth with the necessary social and transport infrastructure. However, that would depend on the Government having a strategy; at present, I am afraid, they do not. Although there are exceptions, in general terms it is simply a fact that central Government in England do not play a clear strategic role in site identification or the delivery of new large-scale communities.

The national infrastructure strategy sets out a range of investment priorities, but it does not provide a framework that makes clear which areas are preferred for long-term priority housing growth and their relationship to infrastructure investment. National planning policy on delivering sustainable, large-scale housing developments is incredibly vague and provides little in the way of encouragement or guidance to local authorities contemplating meeting local housing need in key strategic locations.

The Conservative Administration of the right hon. Member for Maidenhead (Mrs May) changed the law in 2018 to encourage locally led development corporations to act as master developers. However, to the best of my knowledge—the Minister may correct me—none has yet been designated.

In many ways, the root cause of the infrastructure challenges on sites such as those that have been mentioned today is the issue of land value capture. Aside from direct Government grant, development of those sites is reliant on developer contributions in the form of section 106 or the community infrastructure levy to meet essential infrastructure needs. However, those contributions are often not sufficient to provide all the infrastructure needed on those sites. I am surprised that this has not been mentioned today, but that is at least partly a direct consequence of the impact of viability rules set out in the 2012 national planning policy framework, which allow developers to game the system and drive down section 106 contributions. Although in some cases local authorities could be more robust with developers, the national planning policy framework ties their hands behind their backs in terms of what they can extract as public gains under section 106.

The Minister will no doubt point to the Government’s proposals, mentioned most recently in the levelling-up White Paper, to introduce a new infrastructure levy. However, at present, we have no idea how it would apply to large-scale development or deal with areas of low demand, how much it would yield or the date by which we can expect it to be implemented. There is an immediate deficit, as the hon. Member for South West Bedfordshire said in his opening remarks.

Given how heavily the Government appear to be leaning on the new levy as a means to secure affordable housing and the infrastructure communities need, perhaps the Minister might give us a sense of what the new levy will look like, what form it will take and when it will be brought before the House for consideration. Indeed, he might even go so far as to give Members a straight answer to the more fundamental question of whether the Government still intend to legislate for a reform of the planning system in this Parliament.

To conclude, this debate has highlighted a problem that is not confined to a handful of sites or to particular parts of England, but is the inevitable outcome of the current planning system, which does not provide the necessary social and transport infrastructure on major sites as a matter of course. Addressing that problem requires a fundamental change of approach on the part of the Government, not just tinkering around the edges with individual infrastructure funding streams.

Real benefits can be gained if the Department is willing to grapple seriously with the problem, not only in delivering a marked increase in housing supply but in terms of the quality and sustainability of the new communities that could be created. The alternative is that we continue to see more poor-quality housing in inappropriate locations without the necessary infrastructure that residents need to flourish. Members across the House do not want to see that outcome, and I suspect the Minister does not want to see it either, but do the Government have the political will to re-examine the flawed system that they are currently presiding over?

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.

The Minister may not be able to answer, but may I tempt him to name the legislative vehicle by which the new infrastructure levy will be introduced?

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.