Developer Contributions Supplementary Guidance

1. Access to healthcare is an essential service for a good quality of life. Our approach to adopting an infrastructure first is to direct development to where there is existing infrastructure. Appraisals of infrastructure is required to understand the existing capacity, where there is spare capacity to accommodate growth, or where extensions or new infrastructure can be created. ‘Community infrastructure’ in this context means primary healthcare (often referred to as General Medical Services (GMS)) delivered in Primary Care Premises. 

2. The planning, resources and operational oversight for the range of NHS and local authority care services, including primary care, is responsibility of the Edinburgh Health and Social Care Partnership, which is governed by the Edinburgh Integration Joint Board (IJB). 

3. Most of the current practices in Edinburgh are independent contractors, with only some managed directly by the EHSCP. However, it is the EHSCP that works with all Primary Care practices to plan for future provision and respond to the growth in population, including impacts of new development through Local Development Plans. 

Policy Context 

4. NPF4 Policy 15 requires development proposals to contribute towards local living in 20-minute neighbourhoods, with access to health and social care facilities.  

5. Policy 18 requires development proposals to mitigate their impact on infrastructure, and allows for planning conditions, obligations or other legal agreements to be used to ensure that provision is made to address impacts on infrastructure. This is to ensure an ‘infrastructure first’ approach to development.  

6. City Plan 2030 Policy Inf 3 criterion c) requires that proposals deliver or contribute towards primary healthcare infrastructure capacity – proposals to provide floorspace for the provision of new facilities or to extend existing facilities – where relevant and necessary to mitigate any negative impact, and where commensurate with the scale of proposed development.   

7. Table 12 in Part 4 of the Plan sets out what the healthcare requirements are in order to deliver the development strategy and which developments those requirements relate to.  The actions in Table 12 have been informed by a revised healthcare appraisal prepared by the Edinburgh Health and Social Care Partnership in November 2022 (see summary below Evidence Base). 

8. Where relevant, Place Based Policies set out the requirement in principle to contribute towards healthcare infrastructure. Opportunities to co-locate primary care practices with other community infrastructure should be explored with early engagement between developers and planners with NHS and EHSCP.  

Evidence Base 

9. An initial Healthcare Appraisal was prepared to support the Proposed City Plan 2030 and published alongside the Proposed Plan in September 2021. This provided an overview of the likely impact of City Plan 2030 on the existing capacity. This builds on the actions identified in the LDP 2016 Healthcare Appraisal to respond to LDP 2016’s growth, actions which are updated in each iteration of the LDP Action Programme.  

10. To support the response to representations and to provide more detailed evidence of healthcare requirements to address the impact of Proposed City Plan development, a report was prepared by the Edinburgh Health and Social Care Partnership: ‘Population Growth and Primary Care Premises Assessment: Edinburgh 2022 – 2030’ for circulation to the GP practices/Board and then a further report prepared with Planning in November/December 2022: Population Growth and Primary Care Premises Assessment: Edinburgh 2022 – 2030 City Plan Appraisal Version (Nov/Dec 2022). The Partnership is an organisation involving both Council and NHS staff and is responsible for delivering health and social care services in Edinburgh. This has provided more detail of planned additional capacity required to mitigate the cumulative impact of population increase, LDP1 and Proposed City Plan. It explains the funding available for GMS and why contributions are sought for capital costs for new infrastructure for expanded population. While population increases trigger an increase in central revenue allocations for healthcare provision (and allocations to Health Boards is adjusted by central government for prescribing costs) this is not the case for capital investment in new infrastructure required for expanded population. This is the main reason that development must contribute to mitigate the impact with developer contributions towards actions to increase the physical capacity of practices.  

11. The appraisal illustrates the pressure on GMS which has seen reduced number of practices and higher average patients registered per practice since 2009.  The revised healthcare assessment firstly looks at changes in Edinburgh’s population, and the growth in population associated with committed housing developments and its impact on existing medical practices.  It then sets out proposals to mitigate the impacts of those committed developments, creating a baseline.  It is clear from the assessment that there is a lack of capacity to accommodate the additional population from committed developments.  The assessment then looks at the impacts of new population generated by the new housing developments in the Proposed City Plan.  It then clearly identifies a series of actions to mitigate those impacts, and specifically identifies which developments relate to which specific actions.  

12. It is the intention to review the healthcare appraisal annually and provide annual locality summaries. The actions from healthcare appraisal and updates will be set out in detail in the Action Programme and subsequent Delivery Programme, and include further information on delivery funding.