Practice manager Luan Stewart describes how to tap into a little known source of funding to help meet the cost of improvements to GP premises
As services grow in general practice and new roles are being added under the Additional Roles Reimbursement Scheme, our practices are becoming full to bursting.
When new housing estates are built, this can put further strain on healthcare facilities in the area. This may get worse given the Government is pledging 1.5 million new homes in their five-year term.
Aside from that, many GP surgery buildings are already run down and need a cash injection to improve them and increase the number of clinical and admin rooms. But even with the new improved premises grants, where ICBs can offer 100% funding, there is simply not the money to keep up with the rising population.
Practices in England and Wales are often unaware that a pot of money under Section 106 and the community infrastructure levy (CIL) is available for improving health facilities.
The link between planning and health is long established and this funding provides an opportunity for them to work together to improve access to better healthcare facilities for patients.
All new housing estates are now supposed to consider health within their planning applications, making more money available for updated buildings and even new health centres. Unfortunately, this money is not widely advertised.
What is Section 106 money and CIL?
Section 106 agreements are part of the Town and Planning Act 1990.
The strong link between local planning authorities and the need to improve health inequalities led to a legal agreement that when proposals are submitted for building housing estates, funding can be negotiated from developers to be put towards the community and social infrastructure.
This funding commonly known as ‘Section 106’ must be spent on infrastructure to improve healthcare, social care and transport links.
In addition, the 2008 Planning Act offered a further source of funding, the Community Infrastructure Levy (CIL), which is also money that comes from the developers. It is a charge that councils can choose to apply based on the floor space of new development to help pay for improved infrastructure or community facilities.
Some ICB’s have a strategy around obtaining this funding and claim every penny.
What is its purpose?
Section 106 funding and CIL pots of money have been put into place as new houses involve new patients moving into an area, which can put a strain on local services. As the population grows, surgeries need to grow with it.
The money can be used to reconfigure or expand health centres, or where there is a large amount of new housing, build brand new medical centres, to meet increased patient user numbers.
It can also be used to increase capacity by adding extensions or converting admin space (for example, space used to house patient records) into new clinical space.
Patient increased access is currently worked out based on the average occupancy of 2.4 people per dwelling/home. As an example (and the maths is complicated so I won’t go into detail) 480 new houses could add an extra 1,918 of GP and nurse consulting hours to a practice per year.
How can it be accessed by practices?
If you are in an area where there are housing estates being built, the process for claiming this money is fairly easy.
To start to gather information, check with the local planning authority (which usually sits within your local council) for any initial plans for new houses being considered. Find out how many houses this would involve.
Each ICB should have an estates lead, who will need to be actively working with the councils and planning departments under their written agreements.
They will also be responsible for working with you to obtain this money where available. Make contact, ask them to share the ICB’s estates policies with you and enquire whether there is any CIL or section 106 funding available to help you. Also find out whether the ICB is ready to apply for funding.
To release the healthcare contributions to the ICB, the estates lead needs to submit a detailed plan of work to the developer, since they pay out the Section 106 money. This plan is something that will have to be drawn up by the manager of the practice/s concerned and then discussed with the estates lead.
There will be a form to complete by the ICB, and once you have successfully secured the money, practices normally have up to 10 years to complete the work.
Practices will need to work with the ICB estates lead to ensure the project is completed. Do be aware that if the work isn’t carried out the money secured will have to be paid back to the developer – with interest.
If you are in an area with several housing estates being built, you can make a claim on more than one pot of money. This can be worth thousands of pounds.
Practices can work alone or apply for this funding as a primary care network, provided it benefits the whole network. This can mean sharing the workload and the application process for the funding.
It’s important to note that, alongside any improvement grants, practices will be expected to claim further funding under the Premises Costs Directions 2024. Practice managers will need to complete a project initiation document (PID), which is a formal business case-type application.
A word of caution
You need to be sure you are ready for a building project, there is disruption while it happens, but the end result means new rooms and great clinical space to work in. Notional rent is worked out and abated as appropriate for any improvement grant, to cover the additional space.
If you are planning a development, even in the future, I strongly advise finding out what money may be available from your ICB via these pots of money. You cannot really afford not to!
Luan Stewart is practice manager at Sabden and Whalley Medical Group in Lancashire, and has substantial experience managing GP surgery renovation and extension projects, as well as applying for Section 106 funds. Luan also teaches estates and project initiation document (PID) writing to practice managers in Lancashire and Cumbria.
