Agenda item

The Committee considered a report of Leicester, Leicestershire and Rutland Clinical Commissioning Groups (LLR CCGs) which provided an update on progress towards developing a Primary Care Estate Strategy. A copy of the report, marked ‘Agenda Item 12’, is filed with these minutes.

The Committee welcomed to the meeting for this item Tim Sacks, Head of Estates Planning, LLR CCGs.

Arising from discussions the following points were noted:

(i)          The previous Estates Strategy was completed in the period 2008-2010 therefore it was now out of date and the new version would be significantly different as circumstances had changed greatly since then. NHS England had funded the latest baseline survey regarding Estates. The CCG was confident that the target to have Phase 3 of the process completed by the end of December 2020 would be met. Members were reassured that the new Primary Care Estates Strategy would be a living document which would be regularly revised and if the planning guidance changed as a result of the August 2020 Government White Paper on Planning then the Estates Strategy could be updated to reflect the new guidance.

(ii)         Members emphasised the need for health infrastructure to match housing and population growth. Members asked to be more involved in the process for deciding where health facilities were to be located and how many patients the services could accommodate, in order that members could give reassurance to local people that there would be enough provision. In response to a request from a member that Local Authorities be able to feed into the draft version of the Primary Care Estates Strategy it was explained that the CCG was not at the stage of producing a draft yet and timescales for publication of the document had not yet been agreed but partners would be involved at the appropriate time. The CCGs acknowledged that improvements did need to made in the way the process under Section 106 of the Town and Country Planning Act 1990 was communicated to Councils and Councillors and reassurance was given that in future members would be involved when their division was impacted. It was intended that in future the Planning process would give greater clarity to what the CCGs’ intentions were with using the Section 106 monies; whether a new facility would be built or existing facilities be improved. As part of the process the CCGs would give consideration to whether public sector premises could be used to provide health services from. Members were pleased to see that there would be more joint working between health partners and local authorities in regard to planning health infrastructure and identifying need.

(iii)       Members asked that when the CCGs were considering need they took into account the demographics of the population living in a particular area and the amount of specialist housing being built. In response it was acknowledged that housing was not generic and the demographics of the population were taken into account when assessing what infrastructure was needed, and more work would be carried out in relation to this in future Estates planning.

(iv)       A member asked that the Primary Care Estates Strategy did not just focus on need created by population growth and new housing but also considered the needs of existing communities. It was acknowledged that in most geographical areas the health facilities were not underutilised, they were often overstretched therefore Estates Planning needed to give due consideration to existing communities.

(v)        It was important that Section 106 monies were received early in the process rather than once houses had already been built and inhabited so that existing health premises were not overrun. In response to a query from a member as to whether rent abatements were the best way to spend Section 106 monies and whether it should be spent on new equipment instead, it was explained that the Section 106 contributions were used to fund the capital expenditure necessary to improve, extend or build health premises.  The CCGs did not have capital allocations therefore they could not give capital funding to GP Practices. This is why the Section 106 contributions were so important. When the contributions were used, the  CCGs were able to abate the rent paid to the practice, for fifteen years, which reduced the additional pressure on revenue budgets. 

(vi)       New premises did not always lead to new staff, and recruitment was a problem however it was more difficult to recruit staff for premises that were in need of maintenance therefore it was important to focus on the quality of the premises first. Where there was a population increase for a particular area, that was likely to result in an increase in the list size for a GP Practice and consequently an increase in revenue. GP Practices were required to provide services for the patients in their area and although CCGs could not instruct GP Practices to spend the money in a specific way on additional staffing, it was likely that as list sizes grew there would be increased spending by GP Practices on staffing and recruitment would take place. The CCG could only intervene where the quality of services the GP Practices were providing was below the standard expected, and numbers of staff would form part of any review process.

(vii)      A member suggested that the hub and spoke model was better for GP Practices as patients had to travel less far and it was more environmentally friendly. In response it was explained that Hubs/branch surgeries were hard to staff and there were economies of scale with bigger surgeries and more services and appointments could be provided.

(viii)    In response to concerns that due to Covid-19 patients would be asked to wait outside GP Practices during the winter, it was clarified that patients were being asked to attend on time and not arrive early which would avoid the need for waiting outside, and if patients did need to sit in the waiting area they would be required to wear face masks.

RESOLVED:

(a)        That the update on progress towards developing a Primary Care Estates Strategy be noted and the proposals for how the system should work in future be welcomed.

(b)        That officers be requested to provide a report to the Committee on the Primary Care Estates Strategy when the document is completed.