Planning Permission for a Clinic or Day Surgery: Use Class E(e) in Practice

Planning Permission for a Clinic or Day Surgery: Use Class E(e) in Practice

Since the earlier regulatory reform in September 2020, the provision of medical or health services has fallen within Use Class E, which means many changes of use from retail, office or other commercial premises to a clinic or day surgery no longer require planning permission. Parking, highways access, operating hours and any building works can still trigger planning requirements, so confirm the position with the local planning authority before exchanging contracts on a lease.

This article is not planning advice. It explains the commercial checks that operators typically work through when converting or leasing premises for clinical use. If your proposal involves structural change, extended hours, or a site with access constraints, instruct a planning consultant before committing.

What Use Class E covers

Use Class E was introduced by the predecessor Town and Country Planning (Use Classes) (Amendment) (England) Regulations 2020 and groups together what were previously separate uses: shops, offices, cafés, light industrial and health services. Sub-class E(e) covers the provision of medical or health services, principally to visiting members of the public. A GP surgery, dental practice, physiotherapy clinic, diagnostic imaging centre or day surgery unit ordinarily falls within E(e).

The key commercial consequence is that moving from, say, a former estate agency (previously A2, now E) to a physiotherapy clinic (E(e)) is ordinarily a permitted change within the same use class. No planning application is needed for the change itself. The same applies to a former shop, café or office. This has opened up high street and office stock that might otherwise have sat vacant, and it has shortened the lead time for operators looking to scale across multiple sites.

What still needs permission

Three categories of work or activity commonly require permission or approval even when the underlying use sits comfortably within E(e).

First, building works. If you plan to create additional floorspace, alter the facade, insert new windows for consulting rooms, or make structural changes, you will need to establish whether the works fall within permitted development rights or require a full planning application. Installing a ramp for step-free access or replacing a shopfront to meet Equality Act requirements might be permitted, but removing internal walls to create a larger treatment space can raise structural questions that fall outside the use class framework.

Second, parking and highways. Local planning authorities apply parking standards, and a clinic generating a different traffic pattern from the previous use may require a new assessment. A day surgery unit with patient drop-off, clinical waste collection and staff shift changes can put pressure on on-street parking or access roads. If the local authority considers the intensification material, it may ask for a transport statement or, in larger schemes, a full transport assessment. Motorcycle and cycle parking provision is also commonly scrutinised.

Third, operating hours and associated impacts. Use Class E does not grant carte blanche to operate around the clock. If the previous occupier traded nine to five and you propose early-morning or evening clinics, or Saturday sessions, the authority may treat the change as material and require planning permission. Noise, lighting and activity outside normal commercial hours tend to attract neighbour objection, particularly in mixed-use or residential streets.

What to check before exchange

Before exchanging contracts on a lease, confirm the planning position in writing with the local planning authority. This is normally done through a certificate of lawful use or, more informally, a pre-application enquiry. Both routes carry a fee, but the cost is modest compared to the commercial risk of signing a lease only to discover that the intended use requires permission that may be refused or delayed.

Check the planning history on the public register. If the site has had conditions attached to previous permissions relating to hours, deliveries or parking, those conditions may still bind the property even if the use class has changed. Check the lease itself for any planning-related restrictions. Some landlords impose use restrictions that are narrower than planning law, and breaching a lease covenant can trigger forfeiture even if the planning position is sound.

Check parking provision against the local plan standards. Many authorities publish parking standards by use type, and some distinguish between consulting-room-based services and higher-intensity uses such as diagnostic imaging or minor surgery. If the site falls short, establish early whether a planning application will be needed and whether the authority is likely to accept a reduced provision or a financial contribution in lieu.

What the local authority tends to ask

When a planning application is required, the authority will typically ask for a description of the clinical services to be provided, the anticipated patient throughput, staffing levels and operating hours. For day surgery or diagnostic facilities, expect questions about waste management, particularly clinical waste, and arrangements for patient transport or ambulance access.

Noise can be a material consideration, particularly if the premises adjoin residential accommodation. Air-handling plant, backup generators and patient waiting areas can all generate noise, and the authority may require an acoustic assessment or impose conditions on plant installation and sound insulation.

If the building is listed or within a conservation area, internal alterations and signage will be scrutinised more closely. Installing a new entrance, fire escape or accessible WC can require listed building consent in addition to planning permission. Allow at least three months for determination, longer if the site is sensitive.

When to take specialist advice

Instruct a planning consultant if the site is constrained by flood risk, contaminated land, or proximity to a heritage asset. Instruct one if the proposal involves a significant change in traffic generation, such as a large diagnostic centre or a day surgery unit with ten or more beds. Instruct one if the authority has indicated informally that it considers the proposal a material change requiring permission and you disagree.

If your organisation bids regularly on NHS frameworks or under the Provider Selection Regime, planning delays can jeopardise mobilisation timescales. Frameworks such as RM6291 NHS P23 and procurements governed by the Provider Selection Regime often include commitments on go-live dates, and planning risk should be factored into your bid programme and contingency.

Operators delivering clinical services under NHS frameworks or as part of integrated care board direct awards commonly underestimate the time required to secure premises and satisfy planning requirements. If your growth model depends on opening multiple clinics to a repeatable template, front-load the planning and building control process so that lease commitments and tender commitments remain aligned.

A worked example

Consider a physiotherapy provider tendering for a community musculoskeletal contract under the Provider Selection Regime. The contract requires two clinic locations within a defined catchment, each offering six-day-a-week access. The provider identifies a former building society branch (Use Class E) on a high street and a ground-floor office unit in a mixed-use block (also E).

The building society branch has on-street parking only, and the local plan standard for a health facility of this size is four spaces. The provider writes to the planning authority enclosing a draft operational plan. The authority confirms that the change of use is permitted within Class E but requests a parking survey and a transport statement because of the increase in weekday and Saturday activity. The provider commissions both, at a combined cost of around £3,500, and receives confirmation that no formal application is required provided patient appointment slots are managed to avoid peak parking demand. Total elapsed time: five weeks.

The office unit sits below two floors of flats. The lease restricts use to office purposes between 08:00 and 18:00 Monday to Friday. The provider applies for planning permission to vary the restriction to allow Saturday clinics and weekday evening sessions to 20:00. Two residents object on grounds of noise and parking. The authority grants permission subject to a condition limiting Saturday hours to 09:00 to 13:00 and requiring a final acoustic report confirming that the consulting-room partitions meet Building Regulations Part E. Determination takes eleven weeks. The provider adjusts the service model and proceeds.

In both cases the clinical use fell within E(e), but ancillary factors required formal engagement with the planning system. The lesson is to confirm, in writing, what the authority considers permitted and what requires consent, and to allow time and budget accordingly.

For organisations writing tenders that depend on new premises, see our guidance on NHS tender writing, where we cover how to evidence site readiness and plan B options if planning or estates timescales slip.

Frequently asked questions

Does Use Class E(e) mean I can open a clinic in any former shop without permission?

The change of use itself is generally permitted, but building works, parking requirements, operating hours and waste management can still require planning permission or discharge of conditions. Confirm the position with the local planning authority in writing before committing to a lease or making representations in a tender.

How long does a certificate of lawful use take?

Most local authorities aim to determine a certificate of lawful use within eight weeks, though this is not a statutory deadline. The application fee varies by authority but typically ranges from £150 to £250 for a use certificate. The certificate provides formal confirmation that the proposed use is lawful and can be relied upon if the authority later disputes the position.

Can a landlord restrict use to something narrower than Use Class E even though planning law allows it?

Yes. Lease covenants are a matter of contract, not planning law, and a landlord can impose use restrictions that are more restrictive than the planning use class. Always check the lease alongside the planning position, and if necessary negotiate a variation or licence to alter before exchange.

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