'Encourage development of existing practices'

Online think tank www.2020health.org explains why it backs the Valuing General Practice campaign.

GP has come out strongly supporting the values of traditional general practice.

These views are shared by www.2020health.org, but it recognises that there is a place for a variety of providers and facilities. However these should be introduced in conjunction with established local practices rather than in competition with them.

A simple message such as the BMA's 'Support your surgery' is fine for a media campaign, but the situation is more complicated.

Large GP centres open longer hours and providing additional services are a great idea in places where they are needed. They are not needed everywhere so why is the government effectively forcing every PCT to have at least one?

Setting up a centre in competition with local GPs in areas with high quality practices seems illogical. The cost of building a new centre will be high and running costs are likely to be higher than estimated.

Even if there is £250 million of new money for access, this is not enough. It seems likely that PCT budgets are going to be stretched further and this will continue for years to come.

Surely it would be more cost effective to provide money to existing surgeries to develop a more expansive service?

The National Primary Care Research and Development Centre found that patients would pay three times as much to see a doctor that they know than to have an appointment a day earlier. They value continuity over access. Commercial organisations tend to think along a locum or salaried-type model, which is less likely to provide continuity of care.

The net result will be that where these centres are set up in competition with local practices they might not have many patients to see and end up as an expensive white elephant.

Furthermore, there is evidence that established GPs who know their patients are less likely to refer or order inappropriate tests, thereby reducing NHS costs and providing more focused patient care.

The government's 'one size-fits-all' approach on polyclinics is unlikely to produce the best results. We support the view that general practice is one of the strengths of the NHS and the ongoing doctor-patient relationship is of great importance to both clinical outcomes and cost effectiveness.

Encouraging the development of existing practices in many areas may be a more effective alternative to competitive polyclinics. The government has managed to alienate the profession by attempting to introduce a reasonable idea in a clumsy fashion. I suspect it may come to regret this.

GPletters@haymarket.com.

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