First polyclinic reveals DoH vision

The Centre, in east London, is the type of primary care facility the DoH wants across the country. Edward Davies reports.

Last month, the DoH published a 236-page White Paper outlining its plans to move more work to primary care over the next 10 years.

Central to this vision is the 'one-stop shop' or 'polyclinic' and last week health minister Lord Warner visited the first of up to 30 polyclinic demonstration sites that the DoH wants to establish.

Touring the building, Lord Warner said that GPs would 'see more of this type of building and on a more ambitious scale'.

The building in question is called The Centre and it was built in 2004.

It is surrounded by terraced housing and looks more like a leisure facility or community centre than a traditional GP surgery.

First one-stop shop

The Centre is situated in Newham, east London. It was the first one-stop shop health centre to open under LIFT and cost £4.9 million.

Three GP surgeries are based in the new building, including one aimed at asylum seekers and refugees. All three have their own patient lists and even have their own waiting areas to retain their continuity of care.

However, it is The Centre's other services that the government wishes to highlight.

In conjunction with general primary care, The Centre offers other services linked to primary care such as phlebotomy, optometry and community pharmacy.

There is also a range of outpatient services, including rheumatology, cardiac rehabilitation, diabetes clinics, nurse-led angina clinics, heart failure clinics, an orthoptist, district nurse and health visitor clinics and complementary medicines.

X-ray facilities, pathology services and even a healthy living cafe are in the pipeline.

The White Paper urged a 5 per cent shift in services to community settings like this, but the Newham polyclinic already accounts for 20 per cent of outpatient appointments that would have taken place at the local hospital.

Lord Warner liked what he saw. 'We want to see how far we can safely push the idea,' he said.

It was not the percentage of care shifted to primary care that would show whether a polyclinic was successful, he said, but rather 'simply whether you can clinically and cost-effectively give patients a better experience closer to home, rather than at a hospital'.

'These are purpose-built facilities where GP services are often on the same site as pharmacies and social services, and are not simple like-for-like replacements,' he added.

'The centres are convenient for patients, particularly older patients and those with long-term conditions, because they offer more care closer to home.'

RCGP chairman Dr Mayur Lakhani, who accompanied Lord Warner, said: 'What I've seen here is impressive and, overall, the issue of moving out of hospitals is a good thing.'

He believed that GPs could benefit from working in such centres but would need PCT support. GPs who did not move in would also benefit from access to the services such centres housed. Only three of the 60 practices in Newham are based at the Centre.

Facilities under one roof

'Not every GP has to be in a building like this to benefit,' he said.

'You're bringing many things under one roof that other GPs can refer to.'

Dr Bhupinder Kohli is a GP who has worked in the Newham area for over 20 years. He explained that his practice had not had to fund the scheme, but leased the space back from the PCT.

'We didn't have any of the stress of building the polyclinic or arranging loans and money. Normally GPs have to build or provide their own premises,' he said. 'The build has been of a high quality and was finished on time.'

By the end of this year, it is expected that 100 similar centres will be finished or close to completion thanks to funding through the LIFT scheme.

Lord Warner's visit to The Centre in Newham coincided with the launch of the 'Care Closer to Home Demonstration Group' (CCHDG), which includes BMA and NHS Confederation representatives.

Its task will be to look at providing 'care closer to home' through polyclinics and similar centres in specialties including ENT, orthopaedics, dermatology, urology and gynaecology.

So many more polyclinics are likely to follow.

POLYCLINICS

The Centre in Newham has:
- Three separate GP surgeries.
- Phlebotomy.
- Outpatient clinics, including rheumatology.
- Dentist, pharmacy and complementary medicines.

Future plans
- X-ray facilities.
- Pathology services.

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